Almost half of hospitalisations for chronic conditions that are classified as “potentially preventable” could not have been prevented by different care or patient behaviour in the previous three months, according to an Australia-first study.
The authors say their findings raise questions about the “bluntness” of PPH measure, but also reveal opportunities to intervene to prevent some patients from being hospitalised, especially those with COPD and congestive heart failure (CHF).
The DaPPHne (Diagnosing Potentially Preventable Hospitalisations) study involved 323 patients admitted to three NSW hospitals for congestive heart failure (CHF), COPD, diabetes complications or angina pectoris between November 2014 and June 2017.
All were classified as PPH on the discharge summary.
Data was collected from patients, their GPs and hospital record and an expert panel assessed each patient’s case to determine if their hospitalisation had been preventable.
The study defined “preventable” as an unplanned admission that could have been prevented if – in the three months prior to admission – appropriate, adequate, accessible and good quality support in the community had been available and accessed, and/or appropriate individual health behaviours had occurred.
It found that 46% of the PPH were preventable, 30% were not preventable and 24% were unclassifiable, according to the findings published in BMJ Open.
The Australian Institute of Health and Welfare (AIHW), which uses PPH as a proxy measure of primary care effectiveness, found there were nearly 748,000 PPH in Australia in 2017-18.
The study authors said their findings raised questions about the “bluntness” of PPH as an indicator and revealed the extent to which PPH rates for chronic conditions overestimate the proportion of admissions that are actually preventable.
“That less than half of the PH were assessed as preventable (and nearly one third as not preventable), and the wide range of factors associated with preventability, including site and discharge diagnosis, are important factors in future consideration in the validity and use of PPH as an indicator,” they wrote
They outlined 11 predictors for preventable hospitalisation. They included the hospital site – with patients in the metropolitan hospital six times more likely to have a preventable hospitalisation than those in one of the rural hospitals – and the patients’ diagnosis, with the highest risk of preventable admission found in patients with CHF.
Living alone, regularly requiring help with daily tasks, the patient being assessed by their GP as having social issues that impacted negatively on their ability to manage their health, engaging in very little physical activity and having comorbidities, were all identified as risk factors for preventable hospitalisation.
The authors said the study suggested there were opportunities to intervene to improve clinical care and self-management in the community in the three months prior to the patients’ hospitalisation.