Authors: Claire Morley, Gregory Peterson, Jim Stankovich and Leigh Kinsman
Emergency department crowding is one of the biggest issues facing healthcare systems worldwide. Increased presentations by the elderly have been identified as a potential contributing factor. Patient-perceived access to care has been suggested as one explanation for increased elderly presentations. A group of conditions collectively called Potentially Preventable Hospitalisations (PPHs) are a commonly used measure of patient-perceived access to primary care services. AIM: To investigate the hypothesis that patient-perceived access to care, as measured by PPHs, is a factor leading to increased emergency department presentations and subsequent hospitalisations of elderly patients. METHOD: Six years of inpatient data, from one Australian hospital, were coded to identify PPHs. The data were further divided to identify (i) admissions by those aged ≥75 years and (ii) admissions by patients aged ≥75 years with a length of stay ≤ 2 days (short-stay). Descriptive statistics were used to compare changes in rates of admissions for PPHs versus non-PPHs. RESULTS: PPHs accounted for 7.4% of all admissions and increased by 21% over 6 years, whereas non-PPHs increased by only 1.7%. Twenty-five percent of PPHs were by patients aged ≥ 75 years. PPHs related to chronic disease increased at the greatest rate (16%) for this patient demographic. Short-stay admissions for PPHs accounted for 51% of all PPHs in patients aged ≥ 75 years, and increased by 70% over six years. Congestive cardiac failure (CCF) was the most common associated condition, accounting for 21% of all short-stay PPHs in the elderly. CONCLUSION: Our analysis suggests that patient-perceived access to care, as measured by PPHs, is a driver of increased emergency department presentations and subsequent hospital admissions of patients aged ≥ 75 years. Short-stay admissions for chronic conditions are the biggest contributor. Understanding elderly patients’ perceptions of access to chronic care management outside of the hospital setting may provide insights into how best to improve access to required services, and thereby reduce the need for expensive, short-term, acute care management of chronic conditions.
Keywords: crowding, access to care, elderly presentations, decision making, chronic care