Electronic supplementary material
The online version of this article (doi:10.1186/1472-6963-12-153) contains supplementary material, which is available to authorized users.
VW None declared. SdeL None. Director of South West London AHSN Health Outcomes Group. SD None declared. GH An employee of Sollis – who provide ACGs as a service to GP practices across England. SM None declared. TD None declared. SH None. Co-chair of South West London AHSN Health Outcomes Group. HA-S None. Chair of South West London AHSN Health Outcomes Group.
VW Conducted the literature review and major contribution to all drafts of the paper. SdeL Conceived the idea for the learning events and review. Leads the South West London AHSN Health Outcomes Group and helped draft and comment on the paper. SD Contributed to the organisation and content of the first learning event and drafts of the paper. GH Contributed to the content of the first learning event and commented on drafts of the paper. SM Contributed to the content of the first learning event and drafts of the paper. TD Contributed to and commented on all drafts of the paper. SH Contributed to and commented on all drafts of the paper and development of the health outcomes group. HA-S Contributed to and commented on all drafts of the paper and development of the health outcomes group. All authors read and approved the final manuscript.
Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare.
We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops.
We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission.
Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.