Using geographic variation in unplanned ambulatory care sensitive condition admission rates to identify commissioning priorities: an analysis of routine data from England

Objectives: To use geographic variation in unplanned ambulatory care sensitive condition (ACSC) admission rates to identify the clinical areas and patient subgroups where there is greatest potential to prevent admissions and improve the quality and efficiency of care.

Methods: We used English Hospital Episode Statistics data from 2011/12 to describe the characteristics of patients admitted for ACSC care and estimate geographic variation in unplanned admission rates. We contrasted geographic variation across admissions with different length of stay which we used a proxy for clinical severity. We estimated the number of bed days that could be saved under several scenarios.

Results: There were 1.8 million ACSC admissions during 2011/12. Substantial geographic variation in ACSC admission rates was commonplace but mental health care and short-stay (<2 days) admissions were particularly variable. Reducing rates in the highest use areas could lead to savings of between 0.4 and 2.8 million bed days annually.

Conclusions: Widespread geographic variations in admission rates for conditions where admission is potentially avoidable should concern commissioners and could be symptomatic of inefficient care. Further work to explore the causes of these differences is required and should focus on mental health and short-stay admissions.