title: Predicting and preventing avoidable hospital admissions: a review.
abstract: The strongest risk factors for avoidable hospital admission are age and deprivation but ethnicity, distance to hospital, rurality, lifestyle and meteorological factors are also important, as well as access to primary care. There is still considerable uncertainty around which admissions are avoidable. In terms of services to reduce admissions there is evidence of effectiveness for education, self-management, exercise and rehabilitation, and telemedicine in certain patient populations, mainly respiratory and cardiovascular. Specialist heart failure services and end-of-life care also reduce these admissions. However, case management, specialist clinics, care pathways and guidelines, medication reviews, vaccine programmes and hospital at home do not appear to reduce avoidable admissions. There is insufficient evidence on the role of combinations or coordinated system-wide care services, emergency department interventions, continuity of care, home visits or pay-by-performance schemes. This highlights the importance of robust evaluation of services as they are introduced into health and social care systems.
authors.affiliation: S Purdy Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine University of Bristol Canynge Hall 39 Whatley Road Bristol BS8 2PS, UK. Sarah.Purdy@bristol.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Purdey
authors.forename: A
authors.initials: A
authors.lastname: Huntley
mesh_terms: D004630:Emergencies; D058006:General Practice; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission; D011320:Primary Health Care / Q000592:standards; D012307:Risk Factors; D013727:Terminal Care; D006113:United Kingdom
keywords: Hospital admissions; older people; systematic reviews