Dataset Information

Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis.

ABSTRACT:

Objective

To examine whether any differential change in emergency admissions could be attributed to integrated care by comparing pioneer and non-pioneer populations from a pre-pioneer baseline period (April 2010 to March 2013) over two follow-up periods: to 2014/2015 and to 2015/2016.

Design

Difference-in-differences analysis of emergency hospital admissions from English Hospital Episode Statistics.

Setting

Local authorities in England classified as either pioneer or non-pioneer.

Participants

Emergency admissions to all NHS hospitals in England with local authority determined by area of residence of the patient.

Intervention

Wave 1 of the integrated care and support pioneer programme announced in November 2013.

Primary outcome measure

Change in hospital emergency admissions.

Results

The increase in the pioneer emergency admission rate from baseline to 2014/2015 was smaller at 1.93% and significantly different from that of the non-pioneers at 4.84% (p=0.0379). The increase in the pioneer emergency admission rate from baseline to 2015/2016 was again smaller than for the non-pioneers but the difference was not statistically significant (p=0.1879).

Conclusions

It is ambitious to expect unequivocal changes in a high level and indirect indicator of health and social care integration such as emergency hospital admissions to arise as a result of the changes in local health and social care provision across organisations brought about by the pioneers in their early years. We should treat any sign that the pioneers have had such an impact with caution. Nevertheless, there does seem to be an indication from the current analysis that there were some changes in hospital use associated with the first year of pioneer status that are worthy of further exploration.

SUBMITTER: Keeble E

PROVIDER: S-EPMC6701574 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis.

Keeble Eilís E Bardsley M M Durand Mary Alison MA Hoomans Ties T Mays Nicholas N

BMJ open 20190818 8

<h4>Objective</h4>To examine whether any differential change in emergency admissions could be attributed to integrated care by comparing pioneer and non-pioneer populations from a pre-pioneer baseline period (April 2010 to March 2013) over two follow-up periods: to 2014/2015 and to 2015/2016.<h4>Design</h4>Difference-in-differences analysis of emergency hospital admissions from English Hospital Episode Statistics.<h4>Setting</h4>Local authorities in England classified as either pioneer or non-pi ...[more]

PMID: 31427314

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Project description:ObjectiveWe aimed to spatially describe hospital admissions for ambulatory care sensitive conditions (ACSC) in England at small-area geographical level and assess whether recorded practice performance under one of the world's largest primary care pay-for-performance schemes led to reductions in these potentially avoidable hospitalisations for chronic conditions incentivised in the scheme.SettingWe obtained numbers of ACSC hospital admissions from the Hospital Episode Statistics database and information on recorded practice performance from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/2016. We fitted three sets of negative binomial models to examine ecological associations between incentivised ACSC admissions, general practice performance, deprivation, urbanity and other sociodemographic characteristics.ResultsHospital admissions for QOF incentivised ACSCs varied within and between regions, with clusters of high numbers of hospital admissions for incentivised ACSCs identified across England. Our models indicated a very small effect of the QOF on reducing admissions for incentivised ACSCs (0.993, 95% CI 0.990 to 0.995), however, other factors, such as deprivation (1.021, 95% CI 1.020 to 1.021) and urbanicity (0.875, 95% CI 0.862 to 0.887), were far more important in explaining variations in admissions for ACSCs. People in deprived areas had a higher risk of being admitted in hospital for an incentivised ACSC condition.ConclusionSpatial analysis based on routinely collected data can be used to identify areas with high rates of potentially avoidable hospital admissions, providing valuable information for targeting resources and evaluating public health interventions. Our findings suggest that the QOF had a very small effect on reducing avoidable hospitalisation for incentivised conditions. Material deprivation and urbanicity were the strongest predictors of the variation in ACSC rates for all QOF incentivised conditions across England.

Dataset Information

Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis.

Objective

Design

Setting

Participants

Intervention

Primary outcome measure

Results

Conclusions

Publications

Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis.

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