title: Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions.
abstract: OBJECTIVE
  We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions.
  
  
  METHODS
  We conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care-sensitive infectious and chronic conditions.
  
  
  RESULTS
  There were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004.
  
  
  CONCLUSIONS
  The introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom e.cecil@imperial.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cecil
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Paediatric Infectious Disease Unit, St George's Hospital, University of London, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom.
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D007239:Infections / Q000453:epidemiology; D065186:Interrupted Time Series Analysis; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D018584:Physician Self-Referral; D012052:Reimbursement, Incentive
keywords: children; out-of-hours health care; pay for performance; primary care; short-stay admissions; trends; unplanned admissions