GeoGRAphic VARiAtion in potentiAllY AVoidAble hoSpitAlizAtionS in FRAnce

Abstract

introduction: Potentially avoidable hospitalizations are studied as an indirect measure of access to primary care. Understanding the determinants of potentially avoidable hospitalizations is of considerable interest to improve the quality, efficiency, and equity of health care delivery. Few studies have tackled the issue of potentially avoidable hospitalizations in France and none at the national level. The aim of this study was to assess potentially avoidable hospitalizations disparities in France in 2012 and to analyze their determinants. Methods: Potentially avoidable hospitalizations were defined according to the method proposed by Weissman. Age and sex standardized potentially avoidable hospitalizations rates were estimated from the national hospital discharge database. Potential determinants were available at the ZIP-code or department level from the INSEE and IRDES databases. A mixed multilevel model was built. Results: In total, 742,474 potentially avoidable hospitalizations occurred (11.4 stays per 1,000 inhabitants). The standardized rate of potentially avoidable hospitalizations ranged from 0.1 to 44.4 cases per 1,000 inhabitants, at ZIP code level. Increased potentially avoidable hospitalizations were associated with a poorer health status, a lower density of acute care beds and ambulatory care nurses, lower median income, and lower education levels. discussion: This study unveils considerable variation in the rate of potentially avoidable hospitalizations, partly explained by primary care. Policy makers should consider routinely measuring potentially avoidable hospitalizations in France.