Measuring potentially avoidable and ambulatory care sensitive hospitalisations in New Zealand children using a newly developed tool.

OBJECTIVES: To use a newly developed tool to measure Potentially Avoidable (PAH) and Ambulatory Care Sensitive (ACSH) Hospitalisations in New Zealand children. To consider whether these tools provide any insights into the role policies or programmes which address the underlying determinants of health (e.g. poor housing, exposure to cigarette smoke, child poverty) might play in reducing hospitalisations in this age group.

METHODS: All acute and semi acute (<1 week of referral) hospitalisations in New Zealand children aged 29 days-14 years, during 2000-2009 were included, along with all hospitalisations for selected dental conditions. The newly developed PAH and ACSH tools were used to determine category membership, with explanatory variables including age, gender, ethnicity and NZ Deprivation index decile.

RESULTS: During 2005-2009, 47.4% of all acute paediatric hospitalisations were considered to be PAH, 34.3% to be ACSH, and 9.7% to be non-avoidable. A further 42.9% were for non-classified conditions. Dental conditions and gastroenteritis were the leading causes of both PAH and ACSH. PAH and ACSH were highest in infants and one year olds, while non-avoidable hospitalisations were more evenly distributed throughout childhood. PAH and ACSH were higher for those from deprived areas and for Pacific and Maori children. Socioeconomic differences for non-avoidable hospitalisations were less marked, with rates being lowest in Maori and Asian children.

DISCUSSION: Large social gradients in ACSH suggest that New Zealand needs to implement policies to increase access to primary care for Pacific and Maori children and those living in more deprived areas. With the majority of presentations being for acute onset infectious and respiratory diseases, such policies must take into account the need for immediate (i.e. same day) and after hours access to primary care. The narrow windows of opportunity (hours-days) available for primary care to prevent hospitalisations for ambulatory sensitive conditions also suggests that New Zealand needs to develop policies and strategies to reduce the underlying burden of disease in the community.