Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study
- M J G Bankart1,
- R Baker1,
- A Rashid2,
- M Habiba2,3,
- J Banerjee4,5,
- R Hsu2,6,
- S Conroy7,
- S Agarwal1,
- A Wilson8
- 1NIHR CLAHRC for LNR, Leicester, UK
- 2Leicestershire County and Rutland PCT, Leicester, UK
- 3University Hospitals of Leicester NHS Trust, Leicester, UK
- 4Department of Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- 5NHS Leicester Leicestershire and Rutland, Leicester, UK
- 6Department of Medical and Social Care Education, University of Leicester, Leicester, UK
- 7University of Leicester, Leicester, UK
- 8Department of Health Sciences, University of Leicester, Leicester, UK
- Correspondence to Dr M J G Bankart, NIHR CLAHRC for LNR, Department of Health Sciences, University of Leicester, 22–28 Princess Rd West, Leicester LE1 6TP, UK;
Contributors AR and RB jointly conceived the study. MJGB and RB designed the study. MJGB conducted the analyses. The first draft of the paper was prepared by RB and MJGB. MJGB, RB, AR, MH, JB, RH, SA and AW all contributed to study design, interpretation of the findings and revision and approval of the final manuscript. MJGB was the guarantor.
- Accepted 7 March 2011
- Published Online First 22 April 2011
Objectives To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates.
Design A cross-sectional study.
Setting Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England.
Participants 145 general practices.
Methods Hospital admission data were used to calculate the rate of emergency admissions from 145 practices, for two consecutive years (2006/7 and 2007/8). Practice characteristics (size, distance from principal hospital, quality and outcomes framework performance data, patient reports of access to their practices) and patient characteristics (deprivation, ethnicity, gender and age), were used as predictors in a two-level hierarchical model, developed with data for 2007/8, and evaluated against data for 2006/7.
Results Practice characteristics (shorter distance from hospital, smaller list size) and patient characteristics (higher proportion of older people, white ethnicity, increasing deprivation, female gender) were associated with higher admission rates. There was no association with quality and outcomes framework domains (clinical or organisation), but there was an association between patients reporting being able to see a particular general practitioner (GP) and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined.
Conclusions The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates.
The views expressed in the paper do not necessarily reflect those of the Department of Health or the NIHR. The study funder played no role in the study design, collection, analysis and interpretation of data, the writing of the article or the decision to submit it for publication. All the researchers had access to the data.
Funding This study is part of a programme of research funded by the National Institute of Health Research (NIHR) and being undertaken by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR).
Competing interests RB has received support from the National Institute for Health Research (NIHR) for the submitted work; AR and MH are employees of Leicestershire County and Rutland Trust, and MH and JB are employees of the University Hospitals of Leicester Trust that might have an interest in the submitted work in the previous 3 years.
Ethics approval The study was an analysis of routinely collected administrative data only. NHS ethics committee approval was not required, but approval was sought and obtained from the University of Leicester Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.