Avoidable Hospitalization among Migrants and Ethnic Minorities in Developed Economies
Avoidable hospitalization (AH) relates to conditions for which hospital admission could be prevented by interventions in primary care. Such conditions, called Ambulatory Care Sensitive Conditions (ACSCs), have been used as a marker of accessibility and primary care effectiveness. A lack of high quality primary and preventive care can in fact result in an increased AH.
There is evidence of differentials on the use of healthcare services between migrants and ethnic minorities living in developed economies and the autochthonous populations, which may in turn generate differentials in the health status.
The aim of this chapter is to address the issue of primary healthcare and preventive health services access of migrants and ethnic minorities in developed economies, using hospitalization for ACSCs as an indicator.
KeywordsMigrants Ethnic minorities Avoidable hospitalization Primary care Quality of care Asthma Diabetes Literature review Developed economies
We wish to thank Andrea Bardin (Resident Physician, Postgraduate School of Hygiene and Preventive Medicine, University of Padua, Italy) for his contribution to the review of the most recent literature about AH among migrants.
- AHRQ Quality Indicators—Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Rockville, MD: Agency for Healthcare Research and Quality, 2001. AHRQ Pub. No. 02-R0203. https://www.ahrq.gov/downloads/pub/ahrqqi/pqiguide.pdf. Accessed 3 July 2017.Google Scholar
- Agency for Healthcare Research and Quality (AHRQ). (2017). Healthcare Cost and Utilization Project (HCUP). https://www.ahrq.gov/research/data/hcup/index.html. Accessed 3 July 2017.
- Agency for Healthcare Research and Quality (AHRQ). (2016, October). Prevention Quality Indicators Technical Specifications Updates – Version 6.0 (ICD-9). https://www.qualityindicators.ahrq.gov/Modules/PQI_TechSpec_ICD09_v60.aspx. Accessed 24 June 2017.
- Busby, J., Purdy, S., & Hollingworth, W. (2015). A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. BMC Health Services Research, 15, 324. https://doi.org/10.1186/s12913-015-0964-3.CrossRefPubMedPubMedCentralGoogle Scholar
- Busby, J., Purdy, S., & Hollingworth, W. (2017b). Using geographic variation in unplanned ambulatory care sensitive condition admission rates to identify commissioning priorities: An analysis of routine data from England. Journal of Health Services Research & Policy, 22, 20–27. https://doi.org/10.1177/1355819616666397.CrossRefGoogle Scholar
- Calderón-Larrañaga, A., Carney, L., Soljak, M., Bottle, A., Partridge, M., Bell, D., et al. (2011). Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: National cross-sectional study. Thorax, 66, 191–196. https://doi.org/10.1136/thx.2010.147058.CrossRefPubMedGoogle Scholar
- Cecil, E., Bottle, A., Sharland, M., & Saxena, S. (2015). Impact of UK primary care policy reforms on short-stay unplanned hospital admissions for children with primary care-sensitive conditions. Annals of Family Medicine, 13, 214–220. https://doi.org/10.1370/afm.1786.CrossRefPubMedPubMedCentralGoogle Scholar
- European Commission Directorate General for Health and Food Safety. (2016). So what? Strategies across Europe to assess quality of care. Report by the Expert Group on Health Systems Performance Assessment. https://ec.europa.eu/health//sites/health/files/systems_performance_assessment/docs/sowhat_en.pdf. Accessed 24 July 2017.
- European Observatory on Health Systems and Policies: Migrants and health. (2014). http://www.euro.who.int/__data/assets/pdf_file/0011/266186/Eurohealth-v20-n4_1.pdf?ua=1. Accessed 3 July 2017.
- Eurostat. (2017). Migration and migrant population statistics. http://ec.europa.eu/eurostat/statistics-explained/index.php/Migration_and_migrant_population_statistics#Migration_flows. Accessed 3 July 2017.
- Falster, M. O., Jorm, L. R., Douglas, K. A., et al. (2015). Sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in Australia. Medical Care, 53, 436–445. https://doi.org/10.1097/MLR.0000000000000342.CrossRefPubMedPubMedCentralGoogle Scholar
- Gibson, O. R., Segal, L., & McDermott, R. A. (2013). A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing. BMC Health Services Research, 13, 336. https://doi.org/10.1186/1472-6963-13-336.CrossRefPubMedPubMedCentralGoogle Scholar
- Gonçalves, M. R., Hauser, L., Prestes, I. V., Schmidt, M. I., Duncan, B. B., & Harzheim, E. (2016). Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil. Family Practice, 33, 238–242. https://doi.org/10.1093/fampra/cmv051.CrossRefPubMedGoogle Scholar
- Heo, H. H., Sentell, T. L., Li, D., Ahn, H. J., Miyamura, J., & Braun, K. (2015). Disparities in potentially preventable hospitalizations for chronic conditions among Korean Americans, Hawaii, 2010–2012. Preventing Chronic Disease, 12, E152. https://doi.org/10.5888/pcd12.150057.Google Scholar
- Johnson, P. J., Ghildayal, N., Ward, A. C., Westgard, B. C., Boland, L. L., & Hokanson, J. S. (2012). Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions. Medical Care, 50, 1020–1028. https://doi.org/10.1097/MLR.0b013e318270bad4.CrossRefPubMedGoogle Scholar
- Khanassov, V., Pluye, P., Descoteaux, S., Haggerty, J. L., Russell, G., Gunn, J., et al. (2016). Organizational interventions improving access to community-based primary health care for vulnerable populations: A scoping review. International Journal for Equity in Health, 15(1), 168.CrossRefGoogle Scholar
- McCormick, D., Hanchate, A. D., Lasser, K. E., Manze, M. G., Lin, M., Chu, C., et al. (2015). Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: Retrospective analysis of hospital episode statistics. BMJ, 350, h1480. https://doi.org/10.1136/bmj.h1480.CrossRefGoogle Scholar
- Mkanta, W. N., Chumbler, N. R., Yang, K., Saigal, R., & Abdollahi, M. (2016). Cost and predictors of hospitalizations for ambulatory care - sensitive conditions among Medicaid enrollees in comprehensive managed care plans. Health Services Research and Managerial Epidemiology, 3, 2333392816670301. https://doi.org/10.1177/2333392816670301.CrossRefPubMedPubMedCentralGoogle Scholar
- Moorman, J. E., Akinbami, L. J., Bailey, C. M., Zahran, H. S., King, M. E., Johnson, C. A., & Liu, X. (2012). National surveillance of asthma: United States, 2001-2010. Vital & Health Statistics. Series 3, Analytical and Epidemiological Studies, 35, 1–58.Google Scholar
- Nielsen, S., Krasnik, A., & Rosano, A. (2009). Registry data for cross-country comparisons of migrants’ healthcare utilization in the EU: A survey study of availability and content. BMC Health Services Research, 9, 210. https://doi.org/10.1186/1472-6963-9-210.CrossRefPubMedPubMedCentralGoogle Scholar
- OECD Health Care Quality Indicator project. (2015, Revision). http://www.oecd.org/els/health-systems/health-care-quality-indicators.htm. Accessed 24 July 2017
- P.Re.Val.E. (2017, Edition). Regional Program Outcomes Evaluation Lazio Region. http://184.108.40.206/prevale2017/index.php. Accessed 24 July 2017
- Passey, M. E., Longman, J. M., Johnston, J. J., Jorm, L., Ewald, D., Morgan, G. G., et al. (2015). Diagnosing Potentially Preventable Hospitalisations (DaPPHne): Protocol for a mixed-methods data-linkage study. BMJ Open, 5, e009879. https://doi.org/10.1136/bmjopen-2015-009879.CrossRefPubMedPubMedCentralGoogle Scholar
- Rechel, B., Mladovsky, P., Devillé, W., Rijks, B., Petrova-Benedict, R., & McKee, M. (2011). Migration and health in the European Union: An introduction. In B. Rechel, P. Mladovsky, W. Devillé, B. Rijks, R. Petrova-Benedict, & M. McKee (Eds.), Migration and health in the European Union (pp. 3–13). Maidenhead: Open University Press.Google Scholar
- Rosano, A., Loha, C. A., Falvo, R., van der Zee, J., Ricciardi, W., Guasticchi, G., et al. (2013). The relationship between avoidable hospitalization and accessibility to primary care: A systematic review. European Journal of Public Health, 23, 356–360. https://doi.org/10.1093/eurpub/cks053.CrossRefPubMedGoogle Scholar
- Sentell, T. L., Ahn, H. J., Juarez, D. T., Tseng, C., Chen, J. J., Salvail, F. L., et al. (2013). Comparison of potentially preventable hospitalizations related to diabetes among native Hawaiian, Chinese, Filipino and Japanese elderly compared with Whites, Hawai’i, December 2006-December 2010. Preventing Chronic Disease, 10, 120340.CrossRefGoogle Scholar
- Sheikh, A., Steiner, M. F., Cezard, G., Bansal, N., Fischbacher, C., Simpson, C. R., Douglas, A., Bhopal, R., & SHELS researchers. (2016). Ethnic variations in asthma hospital admission, readmission and death: A retrospective, national cohort study of 4.62 million people in Scotland. BMC Medicine, 14, 3.CrossRefGoogle Scholar
- Sundmacher, L., Fischbach, D., Schuettig, W., Naumann, C., Augustin, U., & Faisst, C. (2015). Which hospitalisations are ambulatory care-sensitive, to what degree, and how could the rates be reduced? Results of a group consensus study in Germany. Health Policy, 119, 1415–1423. https://doi.org/10.1016/j.healthpol.2015.08.007.CrossRefPubMedGoogle Scholar
- United Nations, Department of Economic and Social Affairs, Population Division. International Migration Report 2015 (ST/ESA/SER.A/384). (2015).Google Scholar
- United Nations. World Economic Situation and Prospects. (2016). http://www.un.org/en/development/desa/policy/wesp/wesp_current/2016wesp_full_en.pdf. Accessed 3 July 2017.
- Urquia, M. L., Glazier, R. H., Blondel, B., Zeitlin, J., Gissler, M., Macfarlane, A., et al. (2010). International migration and adverse birth outcomes: Role of ethnicity, region of origin and destination. Journal of Epidemiology and Community Health, 64, 243–251. https://doi.org/10.1136/jech.2008.083535.CrossRefPubMedPubMedCentralGoogle Scholar
- van Loenen, T., Faber, M. J., Westert, G. P., & Van den Berg, M. J. (2016). The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries. Scandinavian Journal of Primary Health Care, 34, 5–12. https://doi.org/10.3109/02813432.2015.1132883.CrossRefPubMedPubMedCentralGoogle Scholar
- Wagstaff, A. (2009). Social health insurance vs. tax-financed health systems – evidence from the OECD. Policy Research working paper; no. WPS 4821. Washington, DC: World Bank Group.Google Scholar
- Weeks, W. B., Ventelou, B., & Paraponaris, A. (2016). Rates of admission for ambulatory care sensitive conditions in France in 2009–2010: Trends, geographic variation, costs, and an international comparison. The European Journal of Health Economics, 17, 453–470. https://doi.org/10.1007/s10198-015-0692-y.CrossRefPubMedGoogle Scholar
- WHO Europe. (2017). Migration and health: key issues. http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/migrant-health-in-the-european-region/migration-and-health-key-issues#292115. Accessed 5 July 2017.
- William, G., & Noori, T. (2014). Infectious disease burden in migrant populations in the EU and EEA. In: Migrants and health. European Journal of Public Health, 20, 3–6.Google Scholar
- Wright, B., Potter, A. J., & Trivedi, A. N. (2017). Use of federally qualified health centers and potentially preventable hospital utilization among older Medicare-Medicaid enrollees. The Journal of Ambulatory Care Management, 40, 139–149. https://doi.org/10.1097/JAC.0000000000000158.CrossRefPubMedPubMedCentralGoogle Scholar