title: Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation.
abstract: BACKGROUND
  Reducing unplanned hospital admissions is a key priority within the UK. Substantial interpractice variation in admission rates for ambulatory care sensitive conditions (ACSC) suggests that decreases might be possible.
  
  
  OBJECTIVE
  To identify the clinical areas and patient subgroups where the greatest opportunities exist for GPs to improve ACSC care.
  
  
  METHODS
  Cross-sectional study using routine hospital data from patients registered at 8123 English GP practices during 2011 and 2012.
  
  
  METHODS
  The authors used random effects Poisson models to estimate interpractice variation after adjusting for several drivers of healthcare need and availability of local hospital services. Interpractice variation was contrasted across patient subgroups based on age.
  
  
  RESULTS
  There were 1.8 million hospital admissions. Overall, high-utilisation practices had ACSC admission rates that were 55% (95% CI = 53 to 56) greater than low-utilisation practices. Differences of 67% (95% CI = 65 to 69) were found for chronic ACSCs, which was much larger than the 51% (95% CI = 49 to 52) difference exhibited by acute presentations. At least two-fold differences were found for 15 (54%) ACSCs, although large interpractice variations were not ubiquitous. Admission rates were consistently more variable among younger-than-average patients. The most variable conditions tended to disproportionately affect deprived patients.
  
  
  CONCLUSIONS
  Substantial interpractice variation suggests that current efforts to standardise primary care have had a limited effect on unplanned hospital admissions. GPs and healthcare commissioners should ensure they are offering best practice care for the most variable clinical areas and patient subgroups identified in the study, particularly in adults aged <70 years with chronic conditions.
authors: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West, Bristol.
authors: John
authors: J
authors: Busby
authors: Centre for Academic Primary Care; School of Social and Community Medicine, University of Bristol, Bristol.
authors: Sarah
authors: S
authors: Purdy
authors: School of Social and Community Medicine, University of Bristol, Bristol.
authors: William
authors: W
authors: Hollingworth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D058006:General Practice; D005843:Geography; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D058996:Quality Improvement; D006113:United Kingdom; D055815:Young Adult
keywords: ambulatory care; general practice; geographical distribution; patient admission; primary health care