REVIEW ARTICLE

Avoiding Hospital Admissions

- What does the research say?
The Kings Fund, Ideas that change health care
by Sarah Purdy
December 2010
AGUSTINUS VINCENT
M A D E D W I P E RT I W I
NADA YULIANDHA

K E PA N I T E R A A N K L I N I K I L M U P E N YA K I T D A L A M
R S T I N G K A T I I K A R T I K A H U S A D A , K U B U R AYA
2016

ebimbing ; dr. Iqbal Lahmadi, Sp. PD

 Introduction
Hospital Emergency
admission admission
That are not predicted
and happen at short
notice because of
perceived clinical need,
NHS 2010
Represent 65% of hospital
bed days in England
NHS is
avoiding -) rising unit costs compared to
hospital other care
admission or -) disruption : inpatient waiting
unplanned list
Aims
What interventions work in reducing
avoidable admissions?
Who is at risk, and how do we identify them?
Which admissions are potentially avoidable?
Which interventions work in:
primary care
social care
emergency care
discharge from hospital
Who is at risk of emergency
admission?
Age
Who is at risk of emergency
admission?
How do we identify those at risk?
Interventions to reduce hospital
admission
Self
manageme
nt
Interventio
ns in
primary
care
Telemedicin Barlow et al. 2007, the most effective
e telecare interventions appear to be
automated vital signs monitoring and
telephone followup
Case -) Some studies : beneficial to advocate
manageme patient with risks, management, related to
nt his/her chronic illness. Best with nurses
supportive care
-) Nurses supportive care takes more costs
-) there are pros and cones
Interventions in hospital
reducing re-admission
Hospital- Discharge
Admitted
based case from
frequently
management hospital

> 3 times -) reduced Shepperd, 2010 :

admitted -> 6% re- -) Strong evidence only
programme admission comes from structured
d as -) no benefits inpatient discharge
outpatient planning
-) reduced about 15%
of re-admission
 Conclusion & recommendations
(page 1)
National policy-makers should:
1. encourage commissioners to implement evidence-
based interventions for avoidable admissions, and
to evaluate their impact in the local context
2. consider the impact of socio-economic deprivation
and other socio-demographic factors when
designing policy around admission rates
3. aim to increase self-management among people
with long-term conditions where there is evidence
of benefit.
 Conclusion & recommendations
(page 2)
Hospital providers and commissioners should:
1. be clear about which admissions they
consider to be avoidable, what proportion of
these admissions are avoidable, and how
these admissions should be coded and
measured
2. Implement evidence-based interventions as
follows:
multidisciplinary interventions and
telemonitoring for patients with heart failure
and assertive case management for patients
with mental health problems
hospital at home
closer integration of primary and
 Conclusion & recommendations
(page 3)
3. continue to implement acute assessment
units, but consider the overall impact on
number of admissions
4. aim to increase self-management among
people with long-term conditions where
there is evidence of benefit.
In addition, commissioners should:
5. disinvest in programmes where there is
robust evidence that they have little or no
effect
6. evaluate all new interventions, as even
those that have proved beneficial in other
settings may not be transferable to the
 Conclusion & recommendations
(page 4)
Primary care providers should:
1. aim to increase continuity of care with a GP
2. consider the impact of local, out-of-hours
primary care arrangements on avoidable
admissions
3. consider closer integration of primary and
social care, evaluating the outcomes of any
new interventions
4. consider closer integration of primary and
secondary care, evaluating the outcomes of
any new interventions.
Thank you