Exploring variation in ED attendances and acute hospital admissions for Ambulatory Care Sensitive Conditions: A federated data analysis Richard Jacques1, Rebecca Simpson1, Madina Hasan2, Simone Croft2, Richard Campbell1, Peter Bath1, Susan Croft1, Suzanne Mason1 and the HDR UK Regional Linked Data Consortium 1SCHARR, Division of Population Health, 2Data Connect Email: r.jacques@sheffield.ac.uk 7 regions and 23 ED and 26 APC sites Internal Analysis: - 1 region and 5 sites External Analysis: - 6 regions and 21 sites Inpatient Data (APC) 01/11/2021 to 31/10/2022 Adults (18+) Completed acute emergency admission ED Data (ECDS) 01/11/2021 to 31/10/2022 Adults (18+) Unplanned first emergency care attendances Type 1 ED Aim Methods Federated multi-regional analysis Pre-specified aggregate-level tables (split by ACSC and non-ACSC): • patient demographics • attendance/admission characteristics • attendance/admission outcomes. The aggregate-level data were combined by the lead site to produce overall summary statistics and make comparisons between hospitals. ACSCs are conditions where effective community care and case management can help prevent the need for hospital admission. Identify potentially avoidable acute admissions focussing on ambulatory care sensitive conditions (ACSCs). Understand variation across the country in acute hospital admissions and Emergency Department (ED) attendances. ED Data Inpatient Data ED data • High proportion ED attendances are with ACSC, significant variation in attendance rates. • More patients admitted from ED with ACSC than non-ACSC. Inpatient Data • High proportion of admissions are for ACSC, significant variation in admission rates. • A higher proportion of long stays were for ACSC. Overall • Results could indicate a failure of care in pre-hospital settings (i.e., primary and community care). • Further research is needed to establish clearer criteria for potentially avoidable admissions and same day emergency care-eligible patients. Number of first attendances: 32,880 to 114,190. Median number of attendances: 70,963. Overall percentage of ACSC attendances: 30% range 14% to 54% 32% of ACSC attendances result in admission, range 4% to 48%. 23% of non-ACSC attendances result in admission, range 7% to 41%. Number of admissions: 3,960 to 51,905. Median number of admissions: 27,388. Overall percentage of ACSC admissions: 41% range 21% to 61% The most common conditions were: 1. Low risk chest pain (13.5%) 2. Lower respiratory tract infection or community acquired pneumonia (10.6%) 3. Falls including syncope and collapse (7.8%) 4. Abnormal liver function (5.9%) 5. Urinary tract infection (5.8%). Higher proportion of short stays (<2 days) admissions for non-ACSC (51% vs 47%) Higher proportion of longer stays (2 days or over) for ACSC conditions (53% vs 49%). Median length of stay range: 0 - 5 days for ACSC 0 - 5 days for non - ACSC. The most common conditions were: 1. Condition unspecified (24.8%) 2. Low risk chest pain (9.7%) 3. Lower respiratory tract infection or community acquired pneumonia (9.1%) 4. Upper GI haemorrhage (6.9%) 5. Supraventricular tachycardias (4.3%). This research is part of, and funded by the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058)