title: Something is amiss in Denmark: a comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente.
abstract: BACKGROUND
  As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems.
  
  
  METHODS
  Using a historical cohort study design, age and gender adjusted population rates of hospitalisations for angina, heart failure, chronic obstructive pulmonary disease, and hypertension, plus rates of 30-day readmission and mortality were investigated for all individuals aged 65+ in the DHS and KP.
  
  
  RESULTS
  DHS had substantially higher rates of hospitalisations, readmissions, and mean lengths of stay per hospitalisation, than KP had. For example, the adjusted angina hospitalisation rates in 2007 for the DHS and KP respectively were 1.01/100 persons (95%CI: 0.98-1.03) vs. 0.11/100 persons (95%CI: 0.10-0.13/100 persons); 21.6% vs. 9.9% readmission within 30 days (OR = 2.53; 95% CI: 1.84-3.47); and mean length of stay was 2.52 vs. 1.80 hospital days. Mortality up through 30 days post-discharge was not consistently different in the two systems.
  
  
  CONCLUSIONS
  There are substantial differences between the DHS and KP in the rates of preventable hospitalisations and subsequent readmissions associated with chronic conditions, which suggest much opportunity for improvement within the Danish healthcare system. Reductions in hospitalisations also could improve patient welfare and free considerable resources for use towards preventing disease exacerbations. These conclusions may also apply for similar public systems such as the US Medicare system, the NHS and other systems striving to improve the integration of care for persons with chronic conditions.
authors.affiliation: Steno Health Promotion Center, Steno Diabetes Center, Niels Steensensvej 8, DK-2820 Gentofte, Denmark. mlsz@steno.dk
authors.forename: Michaela
authors.initials: M
authors.lastname: Schiøtz
authors.forename: Mary
authors.initials: M
authors.lastname: Price
authors.forename: Anne
authors.initials: A
authors.lastname: Frølich
authors.forename: Jes
authors.initials: J
authors.lastname: Søgaard
authors.forename: Jette K
authors.initials: JK
authors.lastname: Kristensen
authors.forename: Allan
authors.initials: A
authors.lastname: Krasnik
authors.forename: Murray N
authors.initials: MN
authors.lastname: Ross
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D060050:Angina, Stable / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D019985:Benchmarking / Q000379:methods*; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D003718:Denmark; D005260:Female; D006279:Health Maintenance Organizations; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011314:Preventive Health Services; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D058996:Quality Improvement / Q000639:trends*