Primary care physicians and avoidable hospitalizations

Background. The rate of admission for avoidable hospital conditions (AHCs) has been proposed as a measure of the ability of a population to access health care. The purpose of this study was to determine the relationship between the availability of primary care physicians and the rate of avoidable hospitalizations.

Methods. Statewide hospital discharge data for general acute care hospitals in Pennsylvania were used to determine age- and sex-adjusted AHC rates in the 26 health service areas (HSAs) in Pennsylvania. The number and type of primary care physician as well as the per capita income for each HSA were obtained from the Area Resource File. Correlations of number and type of physician with AHC rates were obtained.

Results. Only the number of family and general practice physicians (FPs/GPs) per population was significantly correlated with adult and pediatric AHC rates. As the number of FPs/GPs in each HSA increased, the AHC rate decreased. The significant relationship between FPs/GPs and the AHC rate remained after controlling for the effect of per capita income. No significant correlation was found between either the number of general internists and the adult AHC rate or the number of general pediatricians and the pediatric AHC rate.

Conclusions. The availability of FPs/GPs is related to lower rates of hospitalization for certain conditions. Family physicians may provide more effective first-contact access to health care than is provided by either general internists or pediatricians in Pennsylvania. Future studies should address whether care by family physicians is more cost-effective as a result of this reduction in avoidable hospitalizations.

Key words. Primary, health care; health services accessibility; hospitalization; family practice; physicians, family. (J Fam Pract 1994; 39:123-128)

Accessibility is a key characteristic of primary care. This concept may best be defined as the ability of patients to access health care services in a timely manner in response to their needs.[1-3] Many factors influence access to health care in the United States, including number of health care providers,[4,5] availability or transportation to those providers,[6,7] other health care resources (eg, diagnostic and laboratory services), the patient's financial and insurance status,[8-11] and the patient's propensity for using health services.[12]

Several recent studies have suggested that the avoidable hospital condition (AHC) rate can be used as a measure of access to primary care.[13-18] This measure is defined as the hospital admission rate for conditions for which hospitalization might have been avoided if effective and timely ambulatory care had been delivered (eg, early ambulatory care for a person with insulin-dependent diabetes mellitus who has acute gastroenteritis may prevent the development of diabetic ketoacidosis requiring hospitalization).

Weissman and colleagues[13] cite four criteria for selecting avoidable hospital conditions:(1) consensus: have previously published studies used similar indicators? (2) importance: do the conditions represent important health problems? (3) clinical face validity: do the conditions make clinical sense? and (4) data clarity: are the conditions clearly coded in an available data source covering large populations? Using these criteria, they identified 12 potential avoidable hospital conditions.

Several recent studies have suggested that AHC rates...