title: [Avoidable hospitalizations: the sole responsibility of primary care?].
abstract: BACKGROUND
  Avoidable hospitalizations are used as a performance indicator of primary care in many countries. We investigate here the validity and usefulness of this measure both at a global scale and for the French healthcare system.
  
  
  METHODS
  A scoping study was performed to take a critical look at this concept. The different uses of avoidable hospitalizations as an indicator have already been reported in two recent systematic literature reviews.
  
  
  RESULTS
  Rates of avoidable hospitalizations seem to be far more correlated with the socioeconomic attributes of patients than with primary care supply. The few studies conducted in France confirm this international trend. Several weaknesses have been spotted in the building of this indicator: the choice of conditions that can be considered as sources of avoidable hospitalizations, their identification among hospitalization disease codes, the quality of hospital coding procedures, the ecological bias in the data collection of illustrative variables.
  
  
  CONCLUSIONS
  Guidelines for improvement of this indicator are provided. In particular, we discuss the possibility of its use at the scale of the whole healthcare system.
authors.affiliation: Institut de documentation et de recherche en économie de la santé, 10, rue Vauvenargues, 75018 Paris, France; Laboratoire éducations et pratiques de santé - EA 3412, UFR SMBH, université Paris-13, Bobigny, France; Département universitaire de médecine générale - UFR SMBH, université Paris-13, Bobigny, France; PROSPERE, 75018 Paris, France. Electronic address: cartier@irdes.fr.
authors.forename: T
authors.initials: T
authors.lastname: Cartier
authors.affiliation: Institut de documentation et de recherche en économie de la santé, 10, rue Vauvenargues, 75018 Paris, France; PROSPERE, 75018 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Naiditch
authors.affiliation: Laboratoire éducations et pratiques de santé - EA 3412, UFR SMBH, université Paris-13, Bobigny, France; Groupe hospitalier Paris-Seine-Saint-Denis, AP-HP, Bobigny, France.
authors.forename: P
authors.initials: P
authors.lastname: Lombrail
mesh_terms: D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D018447:Medical Futility; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards
keywords: Avoidable hospitalization; Hospitalisation potentiellement évitable; Indicateur de performance; Performance indicator; Primary care; Système de soins primaires