Geographical Distribution of Avoidable Hospital Conditions in Romania

Quality health indicators gained an essential place in attempting to achieve healthcare system performance. Generally, prevention is better and more efficient than cure. In this context, the current state of the art in measuring the outcomes of preventive and outpatient care through analysis of inpatient discharge data is represented by Preventive Quality Indicators that can flag potential problems resulting from a breakdown of health care services by tracking hospitalizations for conditions that should be treatable on an outpatient basis, or that could be less severe if treated early and appropriately. In practice, AHC is useful to identify the potentially preventable hospitalizations in different hospital units, but also the magnitude of preventable hospitalizations in different regions in order to compare the obtained values and thus to provide scientific evidence supporting decision making process. The objectives of the paper are to analyse disparities in potentially avoidable hospitalizations in Romania, in 2013, and to identify some determinants associated with a high level of this indicator. A cross-sectional study conducted on data provided by Romanian DRG database (data for hospital activity) and Romanian Institute of Statistics (data linked with resources availability) was carried out during the year 2013. All 472 public hospitals reporting data were included, regardless the type of hospital activity financing or type of pathology. Uni and bivariate analysis tried to correlate and describe the level of avoidable hospital morbidity by hospitals activity, demographic indicators and by coverage of population with medical personnel and medical units. AHCs valid hospital episodes and AHCs rates were calculated. Data were aggregated by region and district level; cartodiagrams were used for graphical analysis. In Romania, avoidable hospitalizations represent 7% of all hospitalizations. Over half of these hospitalizations have one of the following six diagnoses: primary hypertension (over 20%); hypertensive cardiomyopathy with congestive heart failure (6.3%); bacterial pneumonia, unknown (6%); non-infectious gastroenteritis and colitis, unspecified (5.5%); acute interstitial nephritis (4.6%) and type 2 diabetes mellitus with poor control (3.5%). District with the highest number of avoidable hospitalizations are among districts with medical university centres and those with larger population. High rates of avoidable hospitalizations were associated with high mortality and poor coverage of the population with family medicine cabinets, and hospital beds, and number of doctors and number of nurses. High variations in hospitalizations for AHCs occur across Romania. In the same time, AHCs is moderate/strong correlated to mortality and population coverage with medical personnel and medical units. At least two recommendations emerged from the findings of this research and can be applied for Romania: 1) avoidable hospital morbidity can be addressed by increasing the coverage of population with medical staff and the availability of ambulatory and primary care in areas with high rates of avoidable hospitalizations and 2) in those areas with high rates of AHC it is necessary to analyse in details the situation at territorial level, to implement actions for increasing the availability and accessibility of the population to basic services (including primary care) and to allow participation of all stakeholders and filling-up the local regional strategies measures which include motivating and stimulating the medical staff. Such solutions must be strategic planed and a good implementation of such plan can eventually lead to increasing the equity, quality and efficiency in providing medical services.