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ToolsSaunders, Catherine, Davies, Charlotte, Sidhu, Manbinder and Sussex, Jon (2024) Impact of vertical integration on patients’ use of hospital services in England: An analysis of activity data. British Journal of General Practice, 8 (2). ISSN 0960-1643
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Abstract
Background: Debate surrounding the organisation and sustainability of primary care in England highlights the desirability of a more integrated approach to patient care across all settings. One such approach is ‘vertical integration’, where a provider of specialist care, such as a hospital, also runs general practices. Aim: To quantify the impact of vertical integration on hospital use in England. Design & setting: Analysis of activity data for NHS hospitals in England between April 2013 and February 2020. Method: Analysis of NHS England data on hospital activity, which looked at the following seven outcome measures: accident and emergency (A&E) department attendances; outpatient attendances; total inpatient admissions; inpatient admissions for ambulatory care sensitive conditions; emergency admissions; emergency readmissions; and length of stay. Rates of hospital use by patients of vertically integrated practices and controls were compared, before and after the former were vertically integrated. Results: In the 2 years after a GP practice changes, for the population registered at that practice, compared with controls, vertical integration is associated with modest reductions in rates of A&E attendances (2% reduction [incidence rate ratio {IRR} 0.98, 95% confidence interval {CI} = 0.96 to 0.99, P<0.0001]), outpatient attendances (1% reduction [IRR 0.99, 95% CI = 0.99 to 1.00, P = 0.0061]), emergency inpatient admissions (3% reduction [IRR 0.97, 95% CI = 0.95 to 0.99, P = 0.0062]), and emergency readmissions within 30 days (5% reduction [IRR 0.95, 95% CI = 0.91 to 1.00, P = 0.039]), with no impact on length of stay, overall inpatient admissions, or inpatient admissions for ambulatory care sensitive conditions. Conclusion: Vertical integration is associated with modest reductions in use of some hospital services and no change in others.
| Item Type: | Article |
|---|---|
| Additional Information: | Funding Information: The work reported here formed part of a project funded by the National Institute for Health and Care Research (NIHR), Health and Social Care Delivery Research (HSDR) programme (BRACE Project no. 16/138/31). |
| Uncontrolled Keywords: | general practice,hospital referrals,social sciences,statistics,family practice ,/dk/atira/pure/subjectarea/asjc/2700/2714 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Social Sciences > Research Centres > Centre for Competition Policy Faculty of Medicine and Health Sciences > Research Groups > Health Economics |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 04 Mar 2024 18:36 |
| Last Modified: | 19 Dec 2024 01:11 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/94525 |
| DOI: | 10.3399/BJGPO.2023.0231 |
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