Do hospitals influence geographic variation in admission for preventable hospitalisation? A data linkage study in New South Wales, Australia

BMJ Open
Michael O FalsterLouisa R Jorm

Abstract

Preventable hospitalisations are used internationally as a performance indicator for primary care, but the influence of other health system factors remains poorly understood. This study investigated between-hospital variation in rates of preventable hospitalisation. Linked health survey and hospital admissions data for a cohort study of 266 826 people aged over 45 years in the state of New South Wales, Australia. Between-hospital variation in preventable hospitalisation was quantified using cross-classified multiple-membership multilevel Poisson models, adjusted for personal sociodemographic, health and area-level contextual characteristics. Variation was also explored for two conditions unlikely to be influenced by discretionary admission practice: emergency admissions for acute myocardial infarction (AMI) and hip fracture. We found significant between-hospital variation in adjusted rates of preventable hospitalisation, with hospitals varying on average 26% from the state mean. Patients served more by community and multipurpose facilities (smaller facilities primarily in rural areas) had higher rates of preventable hospitalisation. Community hospitals had the greatest between-hospital variation, and included the facilities wit...Continue Reading

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