Background: In New Zealand there has been increasing interest in reducing avoidable hospitalisations, particularly from conditions treatable in primary care. To date avoidable hospitalisations in children have been monitored using adult tools which contain many conditions irrelevant to children. Further, New Zealand has large socioeconomic gradients in hospitalisations for many paediatric conditions, suggesting that the social determinants of health also heavily influence avoidable hospitalisations in this age group.
Aims: (1) To develop a tool to monitor potentially avoidable hospitalisations in New Zealand children which includes the socioeconomic determinants of health within the conceptualisation of "avoidable"; and (2) Within this broader framework, to identify a sub-set of conditions which are amenable to intervention in primary care.
Methods: Five selection criteria were developed to define Potentially Avoidable Hospitalisations (PAH), and a further two criteria were used to define a subset of Ambulatory Care Sensitive Hospitalisations (ACSH). The principal diagnoses for all acute hospitalisations in New Zealand children (1 month-14 years) during 2003-2005 were then reviewed, and a list of 42 conditions created. This list was sent to 17 health professionals with experience in child health, who were asked to score each condition against the 5 PAH and 2 ACSH criteria.
Results: Twenty-six conditions contributing to PAH were identified, along with 18 contributing to ACSH. PAH tended to be infectious or respiratory in nature, with hospitalisations for chronic medical conditions or surgical problems being viewed as non-avoidable. While a similar pattern was seen for ACSH, viral infections were viewed as non-ambulatory care sensitive.
Conclusions: While the tools developed are a considerable improvement on those used to date, the use of diagnostic coding algorithms to monitor ACSH and by inference, the performance of primary care, remains problematic for a number of reasons. Nevertheless, the broadening of PAH to encompass the wider determinants of health, serves to highlight the role Government social and other policies might play in reducing the large burden of avoidable morbidity currently being experienced in this age group.