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Research ArticleOriginal ResearchA

Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care–Sensitive Conditions

Tobias Freund, Stephen M. Campbell, Stefan Geissler, Cornelia U. Kunz, Cornelia Mahler, Frank Peters-Klimm and Joachim Szecsenyi
The Annals of Family Medicine July 2013, 11 (4) 363-370; DOI: https://doi.org/10.1370/afm.1498
Tobias Freund
1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
MD
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  • For correspondence: tobias.freund@med.uni-heidelberg.de
Stephen M. Campbell
2Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom; and University Hospital Heidelberg, Heidelberg, Germany
MA, Econ, PhD
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Stefan Geissler
1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Cornelia U. Kunz
3Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Cornelia Mahler
1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
RN, MA, Dr Sc Hum
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Frank Peters-Klimm
1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
MD
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Joachim Szecsenyi
1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
MD, MSc
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The Article in Brief

Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care - Sensitive Conditions

Tobias Freund , and colleagues

Background Reducing avoidable hospitalizations lowers health care spending and improves both quality of care and quality of life. Hospitalizations for conditions that can typically be managed effectively on an outpatient basis (ambulatory care - sensitive hospitalizations) are potentially avoidable by optimal primary care. This study examines how primary care physicians rate these hospitalizations and whether and how they can be avoided.

What This Study Found Primary care physicians consider most ambulatory care - sensitive hospitalizations potentially avoidable, attributing the causes to 5 possible categories: system-related causes (eg, unavailable outpatient services), physician-related causes (eg, suboptimal monitoring), medical causes (eg, medication side effects), patient-related causes (eg, delayed help seeking) and social causes (eg, lack of social support). System-related causes aare attributed to 30 hospitalizations (29 percent), physician-related causes to 32 (31 percent), medical causes to 101 (97 percent), patient-related causes to 83 (80 percent), and social causes to 20 (19 percent).

Implications

  • Strategies to avoid such hospitalizations include after-hours care, optimal use of outpatient services, intensified monitoring of high-risk patients, and initiatives to improve patients' willingness and ability to seek timely help as well as patients' medication adherence.

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