The goal of this brief article is to review the medical literature on the relationship between avoidable hospitalization, primary care, and adverse outcomes of medical care. I will also discuss how to measure the quality of health care and what are the relevant characteristics of a good health care system. After reading this article you should be able to gain an understanding of some of the factors that affect hospitalization and avoidability. Careful attention is given to both preventable and treatable hospital admissions. Hospitalization is a complex illness with many interrelated causes.
The common outcome of avoidable hospitalization is emergency department visit. Emergency department visits are associated with poor outcomes because of both the length of time spent in the hospital and the physicians rating of care. In a recent study, physicians were randomly assigned to hospitals with higher or lower physician ratings. Those assigned to higher rated hospitals had less severe adverse effects than those assigned to lower rated hospitals.
Another common outcome of hospitalization is physician level dysfunction. Patients in poor areas of care have poorer outcomes than patients in good areas. To address issues about continuity of care, researchers have explored the concept of physician continuity.
Physician level continuity refers to the extent to which patients can be treated according to their wishes. In contrast, care giving can be dictated by rules and algorithms. Research has explored several theories about the importance of continuity of care. According to one theory, patients in areas of high variability and change have poorer outcomes and hospitalizations.
Another study found that areas of high unemployment were more likely to have a decreased level of hospitalizations for specific chronic diseases. Researchers examined two areas of high unemployment and hospitalization for specific chronic diseases: stroke and congestive heart failure. They found that people in these areas had lower risks of hospitalization for these diseases. The reasons for this finding were unclear but it may be due to unemployment.
Other studies have focused on examining preventable adverse outcomes and how doctors evaluate and treat patients with specific diseases. For example, one study found that doctors are not as likely to prescribe cardiovascular medications for patients with heart disease if they do not believe the patient’s symptoms are serious. This study examined the effect of medical surveillance, which involves regular surveillance of patients and their medical histories for signs and symptoms of acute and chronic conditions and other illnesses.
