ORCID Profile
0000-0001-6564-0728
Current Organisation
University of Sydney
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Publisher: Oxford University Press (OUP)
Date: 18-12-2019
Abstract: Potentially preventable hospitalizations (PPH) are defined as unplanned hospital admissions which could potentially have been prevented with the provision of effective, timely outpatient care. To better understand and ultimately reduce rates of PPH, a means of identifying those which are actually preventable is required. The Preventability Assessment Tool (PAT) was designed for use by hospital clinicians to assess the preventability of unplanned admissions for chronic conditions. The present study examined the ability of the PAT to distinguish between those unplanned admissions which are preventable and those which are not, compared to the assessments of an Expert Panel. Data were collected between November 2014 and June 2017 at three hospitals in NSW, Australia. Participants were community-dwelling patients with unplanned hospital admissions for congestive heart failure, chronic obstructive pulmonary disease, diabetes complications or angina pectoris. A nurse and a doctor caring for the patient made assessments of the preventability of the admission using the PAT. Expert Panels made assessments of the preventability of each admission based on a comprehensive case report and consensus process. There was little concordance between the hospital doctors and nurses regarding the preventability of admissions, nor between the assessments of the Expert Panel and the hospital nurse or the Expert Panel and the hospital doctor. The PAT demonstrated poor concurrent validity and is not a valid tool for assessing the preventability of unplanned hospital admissions. The use of Expert Panels provides a more rigorous approach to assessing the preventability of such admissions.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-038415
Abstract: The proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with in idual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable. Three hospitals in NSW, Australia. Community-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records. Assessments of the preventability of each admission by an Expert Panel. 323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29% 47% 58% p≤0.001) and by primary discharge diagnosis (p≤0.001). Significant predictors of an admission being classified as preventable were: study site final principal diagnosis of CHF fewer diagnoses on discharge shorter hospital stay GP diagnosis of COPD GP consultation in the last 12 months not having had a doctor help make the decision to go to hospital not arriving by ambulance patient living alone having someone help with medications and requiring help with daily tasks. That less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.
No related grants have been discovered for Jennifer Johnston.