Analyses of Ambulatory Care-Sensitive Conditions

As well as out-patient treatment, ambulatory care also includes preventive measures such as screening and helping the patient to manage factors which put them at risk of an avoidable hospital admission, such as cholesterol and blood pressure.

Rates of admissions for ambulatory care-sensitive conditions are often used as a measure of the quality of primary care in a local area, and some appear in the Government’s proposed NHS outcomes framework.

This project will help us see what impact preventative care has for patients at risk of avoidable emergency admissions and find out whether new polices really do help them

Our project is examining hospital admission rates for ambulatory care-sensitive conditions over the last nine years, exploring admission trends over time between conditions, age groups and areas. In addition to capturing the pattern of admissions for ambulatory care-sensitive conditions over a long period of time, we hope to be able to test the effects of policy changes at a number of levels:

• Macro level – for example, changes in the GP contract, Quality and Outcome Framework (QOF) payments, and the introduction of practice-based commissioning;

• Meso level – such as primary care trust (PCT) reconfigurations and hospital reconfigurations;

• Micro level – for example, local initiatives in primary and community care such as investment in community matrons, case management and the use of predictive risk modelling, and the introduction of telehealth and telecare to help support patients at home.

Our research aims to:

• Identify patients with ambulatory care-sensitive conditions and track admissions for these conditions over time by individual and by groups of individuals (e.g. in a GP practice, PCT or other geographical area);

• Find out the main national policies affecting the NHS that could have an effect on admission rates for ambulatory care-sensitive conditions, and the timing and location of where such policies were implemented.

The Nuffield Trust will publish the findings from the project in a final report in 2012. This is likely to be of interest to policy-makers, health service managers, commissioners and the wider health service.