Does expanding primary healthcare improve hospital efficiency? Evidence from a panel analysis of avoidable hospitalisations in 5506 municipalities in Brazil, 2000-2014.
Does expanding primary healthcare improve hospital efficiency? Evidence from a panel analysis of avoidable hospitalisations in 5506 municipalities in Brazil, 2000-2014.
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DOI：
10.1136/bmjgh-2016-000242
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发表时间：
2017
影响因子：
8.1
通讯作者：
Powell-Jackson T
中科院分区：
文献类型：
--
作者：
da Silva EN;Powell-Jackson T
医院占卫生支出的主要份额。初级保健可以通过减少可避免的入院来提高医院一级的效率。我们研究了在巴西的家庭健康战略（FHS）的背景下，初级卫生保健的快速扩张是否与可避免的住院减少有关。我们构建了2000-2014年5506个城市的面板数据。我们的主要结果是可避免的住院率，定义参考门诊护理敏感条件（ACSC）的官方列表。暴露变量是FHS覆盖率。我们在市一级使用第一差分模型，控制市的特点和混杂趋势。我们对ACSC列表中的19种疾病中的每一种都运行了类似的模型。2000年至2014年间，FHS覆盖率从14%扩大到64%。同期，可避免的住院率从每1 000人17人下降到10人。计量经济学分析的结果显示，在完全覆盖的情况下，FHS与可避免的住院率增加0.6（95%CI 0.3至0.9; p<0.001）相关。FHS的扩展与初级保健咨询率增加866（95%CI 762至970; p<0.001）相关。FHS与19种疾病中任何一种的住院率降低均无显著相关性。虽然高质量的初级医疗保健可以为人们带来可观的健康益处，但它可能并不总是能有效解决由于可避免的入院而导致的医院层面的效率低下问题。
Hospitals account for the major share of health expenditure. Primary healthcare may improve efficiency at the hospital level by reducing avoidable admissions. We examined whether rapid expansion of primary healthcare in the context of Brazil’s Family Health Strategy (FHS) was associated with a reduction in avoidable hospitalisations. We constructed panel data for 5506 municipalities over 2000–2014. Our primary outcome was the rate of avoidable hospitalisations, defined with reference to the official list of ambulatory care sensitive conditions (ACSC). The exposure variable was FHS coverage. We used first-difference models at the municipality level, controlling for municipality characteristics and confounding trends. We ran similar models for each of the 19 diseases in the list of ACSCs. FHS coverage expanded from 14% to 64% of the population between 2000 and 2014. Over the same period, the rate of avoidable hospitalisations fell from 17 to 10 per 1000 population. Results from the econometric analysis show that the FHS at full coverage was associated with an increase of 0.6 (95% CI 0.3 to 0.9; p<0.001) in the rate of avoidable hospital admissions. Expansion of the FHS was associated with an increase of 866 (95% CI 762 to 970; p<0.001) in the rate of primary care consultations. The FHS was not significantly associated with a reduction in hospitalisations for any of the 19 conditions. While high-quality primary healthcare can deliver considerable health benefits to the population, it may not always be effective in addressing inefficiencies at the hospital level due to avoidable admissions.
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DOI：
10.1016/s0140-6736(14)60075-1
发表时间：
2014-12-13
期刊：
Lancet (London, England)
影响因子：
--
作者：
Marten R;McIntyre D;Travassos C;Shishkin S;Longde W;Reddy S;Vega J
通讯作者：
Vega J
影响因子：
10.7
作者：
Gentzkow, Matthew;Shapiro, Jesse M.;Sinkinson, Michael
通讯作者：
Sinkinson, Michael
影响因子：
5.4
作者：
Garcia-Subirats, Irene;Vargas, Ingrid;Luisa Vazquez, Maria
通讯作者：
Luisa Vazquez, Maria
DOI：
10.1136/bmj.g4014
发表时间：
2014-07-03
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Rasella D;Harhay MO;Pamponet ML;Aquino R;Barreto ML
通讯作者：
Barreto ML
影响因子：
2.8
作者：
Gibson OR;Segal L;McDermott RA
通讯作者：
McDermott RA