Next Article in Journal
Questioning ‘Informed Choice’ in Medical Screening: The Role of Neoliberal Rhetoric, Culture, and Social Context
Previous Article in Journal
Experiences of Frequent Users of Emergency Departments in Health Care Setting in French-Speaking Switzerland: A Qualitative Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Healthcare
Volume 11
Issue 9
10.3390/healthcare11091229
healthcare-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study

by
Alexandre Gouveia
1,*,
Charlène Mauron
1,2 and
Pedro Marques-Vidal
3
1
Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
2
Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland
3
Division of Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
*
Author to whom correspondence should be addressed.
Healthcare 2023, 11(9), 1229; https://doi.org/10.3390/healthcare11091229
Submission received: 23 March 2023 / Revised: 16 April 2023 / Accepted: 24 April 2023 / Published: 26 April 2023
(This article belongs to the Section Healthcare Quality and Patient Safety)
Browse Figures
Review Reports Versions Notes

Abstract

:
Potentially avoidable hospitalizations (PAH) are commonly used as an indicator for healthcare quality and primary care performance. However, data are usually presented in a restricted timeframe and for a specific region, limiting the identification of trends and national patterns. We aimed in this study to calculate rates, identify clinical determinants, and estimate costs of PAH for two frequent lung diseases (asthma and COPD) in Switzerland between 1998 and 2018 using hospital discharge data available for patients aged ≥20 years. PAH were defined according to the Health Care Quality Indicators Project (HCQIP) from the Organisation for Economic Co-operation and Development (OECD). The distribution of PAH in seven administrative regions (Leman, Mittelland, Northwest, Zurich, Eastern, Central, and Ticino) was calculated, along with PAH-associated total hospital days and Diagnosis-Related Group (DRG) estimated costs. Totals of 25,260 PAH for asthma and 135,069 PAH for COPD were identified in the 20-year period. The standardized rates of PAH per 100,000 people for asthma fluctuated from 18.7 in 1998 to 22.5 on 2018. The standardized rates of PAH per 100,000 people from COPD almost doubled from 77.4 in 1998 to 142.7 in 2018. In 2018, the estimated total costs of PAH amounted to 7.7 million CHF for asthma and 91.2 million CHF for COPD. We conclude that PAH for asthma and COPD represent a significant and unnecessary burden and costs of hospitalizations in Switzerland.

1. Introduction

Asthma is a chronic inflammatory respiratory disease affecting from 1 to 8% of the population [1]. Asthmatic patients can be asymptomatic during a prolonged period, but they can also experience acute and severe exacerbations that force them to seek urgent healthcare. A certain number of asthmatic patients are admitted to hospital each year, eventually because of suboptimal disease management in the ambulatory care setting [2].
Chronic obstructive pulmonary disease (COPD) was the third leading cause of mortality worldwide in 2019 according to the World Health Organization (WHO) [3]. COPD is a clinical respiratory syndrome causing persistent and progressive symptoms, such as difficulty in breathing, associated with cough and/or sputum [4]. The progressive course of the disease and the occurrence of exacerbations can be avoided by adequate follow-up and therapeutic optimization in the primary care setting, therefore reducing the burden of COPD emergency and hospital admissions [5,6].
Switzerland is one of the richest countries in the world and has a high performing healthcare system, although rather complex and expensive [7]. In 1997, a total of 406 public hospitals and private clinics existed in Switzerland, but, in recent decades, the hospital network was significantly modified, mostly due to restructuring and fusion of hospitals. In 2018, even if only 281 private and public hospitals were functioning, the hospital network is considered as adequate and well-functioning [8]. Primary care in Switzerland is based on fee-for-service and provided by independent practitioners that work in private practices. Primary care physicians are regularly involved in the management of chronic diseases, such as asthma and COPD. However, from 1992 to 2012, the Swiss primary care workforce became older, more female, and worked fewer hours per week. Thus, it is likely that primary care accessibility has diminished during that period as a consequence of the workforce evolution [9].
Potentially avoidable hospitalizations (PAH) can be used as a measurement of primary care accessibility in an established area [10]. Rates, trends, determinants, and costs of PAH are important factors in assessing the quality of healthcare and provide relevant information for healthcare resources planification in a specific area to optimize prevention and management of chronic diseases in the primary care setting. Yet, PAH seem to be associated with other factors than primary care accessibility or performance, such as socioeconomic attributes of the population and organization of the healthcare system [11]. This challenges interpretation of PAH as a healthcare quality indicator and makes them an interesting topic of research.
The Health Care Quality Indicator Project (HCQIP) from the Organisation for Economic Co-operation and Development (OECD) defined a set of indicators that has been used for healthcare systems monitoring and research. This common set of indicators allows a better interpretation of data and facilitates comparison between countries [12,13]. In the HCQIP, PAH for chronic diseases currently managed in the primary care setting (such as asthma, COPD, heart failure, or diabetes) are applied as indicators for assessing the quality and accessibility of primary care [14].
This study aimed to identify rates, determinants, hospital days, and costs of PAH related to lung diseases (asthma and COPD) among adult patients older than 20 years old between 1998 and 2018 in Switzerland. Few studies have assessed the rates, trends, and determinants of PAH in Switzerland, and, to the best of our knowledge, none has been recently conducted at a national level in such a wide timeframe [15,16,17].

2. Materials and Methods

2.1. Study Design and Length

We conducted a cross-sectional study using nationally representative data for Switzerland obtained from the Swiss Federal Office for Statistics for the period 1998 to 2018.

2.2. Variables, Data Sources, and Measurements

Hospital discharge data from 1998 to 2018 were formally requested to the Swiss Federal Office of Statistics (www.bfs.admin.ch) (accessed on 16 March 2023) to conduct this specific study. The data cover 98% of public and private hospitals within Switzerland and include all stays for each hospital, even those that last less than 24 h. The main cause for hospitalization and the comorbidities were coded using the 10th revision of the International Classification of Diseases (ICD-10) of the World Health Organization (WHO) [18]. The procedures were coded using the Swiss classification of surgical interventions (CHOP) [19]. Aside from the ICD-10 and CHOP codes, the data also contain information regarding gender, age (categorized into 5-year groups), administrative regions (the 26 Swiss cantons (federal states) were attributed to seven different regions, i.e., Leman, Mittelland, Northwest, Zurich, Eastern, Central, and Ticino; further information available as Supplementary Material Table S1), date of admission (limited to month and year), decision of admission (i.e., patient’s or doctor’s initiative, others), type of admission (planned or emergency), type of room (infirmary, semi-private, or private), and PAH-related total hospital days. For calculating the number of hospital days for each PAH, the length of stay (LOS) was expressed using the OECD definition [20].
As performed in another Swiss study conducted by Halfon et al., the Deyo adaptation of the Charlson index was used to assess comorbidities [21,22,23]. The index was computed using data from the current hospitalization, and patients were categorized into 0–1, 2–3, and 4+ score values.

2.3. Potentially Avoidable Hospitalizations

The definition for PAH for asthma and COPD was obtained according to the international OECD Health Care Quality Indicators Project criteria [14] (available as Supplementary Material Tables S2 and S3).

2.4. Consequences of Potentially Avoidable Hospitalizations

The total number of days due to PAH was computed for each year. This number was then divided by 365 to obtain the number of beds that would be theoretically solely dedicated to PAH during that year.
Costs were computed using the Swiss Diagnosis-Related Group (DRG) system. As the value of the DRG point varies according to canton and it was not possible to obtain the values for each year from each canton, costs were computed by applying the cantons’ DRG value for year 2018 (Supplementary Material Table S4). Further, it was not possible to obtain the value for two small cantons (Ticino and Thurgau). Hence, calculations were limited to PAH data from year 2018 using DRG values for 2019 or 2020 from the twenty-four cantons. Data from the Vaud canton suggest that the value changed little (if any change occurred) with time: 10,650 CHF from 2016 to 2020 (1 CHF = 1.01 EUR or 1.07 USD as of 16 March 2023).

2.5. Inclusion and Exclusion Criteria

Only data related to adults (i.e., being at least in age group 20–24) were eligible for analysis. Patients coming from outside of Switzerland or hospitalizations with missing covariates were excluded.

2.6. Statistical Analysis

Analysis was conducted using Stata version 16.1 for Windows® (Stata Corp, College Station, TX, USA). Descriptive results were expressed as number of hospitalizations (percentage) or as average ± standard deviation (SD). Standardized rates of PAH for each calendar year were computed via direct standardization using the 2013 standard EU population.

2.7. Ethics Statement

The data of the Swiss Federal Office of Statistics are available for research purposes, and, therefore, neither specific individual consent nor authorization from an Ethics Committee were needed. Data that are collected routinely in the Medical Statistics of Hospitals are de-identified. In Switzerland, an Ethics Commission approval is not needed for a study using anonymized data where patient identification is not possible [24]. According to this legal framework, this study was not submitted to an Ethics Commission evaluation and approval.

3. Results

3.1. Characteristics of Potentially Avoidable Hospitalizations

A total of 21,369,966 hospital admissions were collected in the initial database. Applying the PAH OECD criteria, an initial sample of 43,440 PAH for asthma was obtained, of which 14,094 (32.4%) were patients coming from outside Switzerland, and 4086 (9.4%) had at least a missing variable, leading to 25,260 (58.2%) PAH that were included in the analysis. For COPD, data from 148,504 PAH were initially assessed, of which 3361 (2.3%) were patients coming from outside Switzerland, and 10,074 (6.8%) had at least one missing variable, leading to 135,069 (90.3%) PAH included in the analysis.
The main characteristics of the PAH for asthma and COPD are summarized in Table 1. For asthma, women represented two-thirds of PAH, while age groups were evenly distributed within the PAH; non-Swiss nationals living in Switzerland represented one-quarter of PAH, and the Leman region accounted also for one-quarter of PAH. Most PAH for asthma had compulsory insurance, and three-quarters were admitted in an emergency setting; in one-third of the cases, the admission was due to the patient and not a doctor; almost 95% of PAH had a Charlson index below 4 (Table 1).
For COPD, men represented most of the cases, and over half of PAH were related to patients aged 70 years or older; Swiss nationals represented the majority of PAH and there was no evidence of a regional predominance. Almost all PAH for COPD had compulsory insurance, and two-thirds were admitted in an emergency setting; in one-fifth of the cases, the admission was due to the patient and not a doctor, and 95% of the PAH had a Charlson index of 2 or more (Table 1).

3.2. Trends of Potentially Avoidable Hospitalizations

The number and the EU-standardized rate (per 100,000 people) of PAH for asthma and COPD are summarized in Table 2 and in Figure 1 and Figure 2. For asthma, the number and rate increased from 1998 to 2001 and decreased afterwards, followed by a slight and continuous increase from 2008 onwards (Table 2 and Figure 1). For COPD, the number and rate increased continuously, with a slight attenuation during 2004–2010 (Table 2 and Figure 2).

3.3. Consequences of Potentially Avoidable Hospitalizations

The number of days for hospital stays (according to the OECD definition) and the number of beds exclusively dedicated to PAH for asthma and COPD are summarized in Table 3 and Figure 3 and Figure 4. For both conditions, the trends mimicked those of the rates, except that for asthma, where no increase was noted after 2008. In 2018, PAH for asthma would occupy 22 hospital beds during the whole year, this number increasing to 233 beds for COPD. Finally, in 2018, the estimated total costs of PAH amounted to 7.7 million CHF for asthma and 91.2 million CHF for COPD.

4. Discussion

According to recent data available from the OECD, Switzerland has a relatively low rate of potentially avoidable hospitalization for both asthma and COPD [25]. Nevertheless, the results from our study show that the rates of PAH due to asthma or COPD in adults aged 20 years or older have been increasing during the last two decades, notably for COPD. This concerning trend for PAH from COPD opposes Switzerland to the majority of the OECD countries, where decreasing COPD admission rates have been reported in recent years (2009–2019) [25]. Our results also show that the consequences of PAH for the Swiss health system, as in number of hospital days or costs, are far from trivial. These results might reflect a progressive reduction in accessibility and continuity in primary care, which has an impact on the timely identification and management of two common chronic respiratory diseases.

4.1. Characteristics of Potentially Avoidable Hospitalizations

In this study, two-thirds of PAH from asthma occurred in women. This finding is coherent with existing data regarding asthma, in which adult women have an increased prevalence and severity of the disease [26]. Surprisingly, the regional rate of PAH for asthma was high for the Leman area, corresponding to 24% of PAH, despite having only 15% of the Swiss population [27]. Considering COPD, and such as in the disease itself, older men represented most of the cases of PAH from COPD [28]. No regional predominance was identified as was found for PAH for asthma, which might suggest that individual patient factors (such as anxiety provoked by disease flares) and others related to disease management plans might also play a concurring role in the underlying mechanisms of PAH.
In our study, we have not found reasonable explanations for the regional disparities that can be a consequence of multiple and independent reasons. Further research might shed light on the impact of Swiss medical demographics (especially in primary care) and on the density of healthcare infrastructures (such as public hospitals or private clinics) in PAH. Switzerland has one of the highest proportions of foreign population residing in the country, so cultural aspects related to healthcare literacy and patterns of healthcare use can also be interesting as complimentary areas of investigation. In addition, recent evidence found the existence of socioeconomic gradients in PAH between 2014 and 2017 in Switzerland, as well as an important geographic variation between cantons [29].
The majority of the admissions of PAH occurred after an emergency visit (78.3% for asthma and 73.7% for COPD). Regarding asthma exacerbations, these can be adequately and timely treated by the patients themselves, and eventually in primary care if required [1]. It is likely that patients suffering from a respiratory exacerbation that is not responding to rescue treatment consider admission to the emergency unit where they can easily access treatment and thus be reassured by regular healthcare surveillance. Primary care providers need to reinforce access, even in out-of-hours, and provide specific and locally adapted recommendations for chronic respiratory patients to avoid, as much as possible, inadequate use of emergency care that can lead to subsequent PAH. Healthcare providers in the emergency units might require additional surveillance and safety networking for comorbid patients and, therefore, choose to hospitalize patients for observation, being less respectful of formal hospitalization criteria. On the other hand, it is also expected, from a public health perspective, that primary care providers provide respiratory patients with an explicit ambulatory pathway for the treatment of acute exacerbations. All those considerations demonstrate considerable room for improvement for the management of acute asthma and COPD exacerbations in the ambulatory setting.
In the analysis in this study, over two-thirds of COPD PAH patients had a Charlson index of ≥2. These numbers are aligned with the results of previous studies showing the presence of comorbidities as a particularly key factor influencing hospitalizations to ambulatory-care-sensitive conditions, especially in COPD [30,31,32]. Comorbidity in older patients can also lead to a more complex and difficult management of multiple chronic diseases in primary care, which might potentially reduce time allocated for the treatment of respiratory diseases.

4.2. Trends in Potentially Avoidable Hospitalizations

The EU-standardized rate of PAH for asthma increased from below 19/100,000 to almost 28/100,000 in 2000, declining afterwards and reversing the trend into a slightly increasing curve between 2008 and 2018. On the other hand, the EU-standardized rates of PAH for COPD almost doubled from 77.4/100,000 in 1998 to 142.7/100,000 in 2018. Seasonal fluctuations related to causal factors, such as viral infections, might explain changes in trends (2002, 2004, and 2014 for asthma; 2003 to 2006 for COPD), although influenza official statistics are not quite suggestive of it [33].

4.3. Implications of Potentially Avoidable Hospitalizations for Public Health

Hospitalizations from asthma or COPD can be a consequence of suboptimal disease management due to several preventable reasons, such as a lack of access to healthcare, insufficient or suboptimal pharmacological treatment, and inadequate disease knowledge, among many others. Even though accessible and continuous primary care services might play a role in preventing hospitalizations due to asthma and COPD, some studies have shown that this association might not be as linear as supposed [34]. In fact, individual factors, such as patients’ gender or age, as well as the presence of comorbidities, increase the risk of PAH independently of the quality of the primary care provided.
Healthcare systems are actually facing different challenges, such as the increase in non-communicable diseases and health inequities, as well as an ageing world population. If PAH are not adequately monitored and become neglected as a public health issue, the number of hospital stays, and corresponding number of occupied beds, will potentially increase in the upcoming years. In 2018, the number of hospital stays of PAH for asthma and COPD corresponded to the occupation of 255 beds for a full year. This is slightly below the median capacity of a tertiary care hospital in Switzerland (298 beds) that would be fully dedicated to managing PAH from two common chronic respiratory diseases [35]. Moreover, the combined costs of PAH for asthma and COPD for the year 2018 reached almost 100 million CHF, representing over half of the Swiss expenditure on prevention and health promotion (193 million CHF) [36]. Overall, our results suggest that PAH for asthma and COPD demand a considerable amount of health and economic resources. Thus, to effectively tackle PAH related to asthma and COPD, multidisciplinary public health strategies are urgently required to promote continuous and effective ambulatory management of chronic respiratory diseases and to increase access of vulnerable, comorbid, and older patients to primary care services [29].

4.4. Strengths and Limitations

Our study presents some relevant strengths. First, the use of exhaustive data with more than 21 million hospitalizations from all the Swiss regions increases the reliability of the obtained results. Second, the use of a long study period, such as 20 years, has permitted to compute trends and provide visual interpretation of the evolution of PAH through two decades. Third, the use of international recognized criteria for PAH allows valuable comparisons with the published literature, especially with existing findings from previous research that has been published in recent years with Swiss data [15,16,17]. This study also allowed an estimation of the costs of PAH for asthma and COPD, which, to our knowledge, was obtained for the first time in Switzerland for such an extended period of time.
There are, however, some limitations in our study. First, the quality and accuracy of hospital data used can be quite heterogeneous among Swiss cantons and regions due to different diagnostic coding habits from healthcare professionals. This lack of consistency might consequently diminish the internal validity of our results. However, this is a well-known limitation of research that is conducted by the use of aggregated data that depend on codification of inpatient main and secondary diagnosis. As stated by Eggli et al., the inpatient main diagnosis provides only a partial view of the cause of hospitalization and, hence, several adjustments, such as individual factors or morbidities, should be added to the indicators for ambulatory-care-sensitive conditions as a way to improve data analysis and interpretation [15]. Second, despite the regular use of PAH as internationally standardized indicators for interpreting the quality of primary care, elevated rates of ambulatory-care-sensitive conditions might be associated with heterogeneous approaches for hospital admission criteria and locally accepted procedures and finally not related to the ambulatory care itself [37]. This is one of the limitations of using PAH as a quality indicator that has been driving research in this field, aiming to improve its pertinence and clinical relevance [38]. Third, no adjustments were made to the regional healthcare supply, whether in terms of hospital care or primary care physicians, or to socioeconomic indicators, or even disease prevalence. This information can provide relevant clues and eventually shed light on some of the regional differences for accessibility and continuity of care. Finally, these findings apply to the Swiss health system and cannot be generalizable to other settings. Still, they provide important information for international comparisons and can reinforce the link between primary care and public health for better healthcare planning and improvement in the quality of care in Switzerland.

5. Conclusions

PAH from asthma and COPD in Switzerland have increased between 1998 and 2018, especially for COPD in the last decade, and represent a significant avoidable burden and cost for the Swiss healthcare system. Further research is needed to understand the reasons and driving forces behind PAH of these common respiratory diseases to be able to tackle this issue on a regional and national level with the active involvement of patients, healthcare providers, and stakeholders.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/healthcare11091229/s1, Table S1: Swiss cantons listed by the seven regions used for the study. Table S2: OECD criteria for potentially avoidable hospitalization due to asthma. Table S3: OECD criteria for potentially avoidable hospitalization due to chronic obstructive pulmonary disease (COPD). Table S4: Swiss cantons’ DRG values for year 2018.

Author Contributions

Conceptualization, A.G. and P.M.-V.; methodology, P.M.-V.; software, P.M.-V.; validation, A.G. and P.M.-V.; formal analysis, P.M.-V.; investigation, A.G.; resources, P.M.-V.; data curation, P.M.-V.; writing—original draft preparation, A.G.; writing—review and editing, A.G., C.M. and P.M.-V.; visualization, A.G. and C.M.; supervision, P.M.-V. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The existing datasets used during the current study are not publicly available and can be provided upon justified request. Data are stored in the University Hospital of Lausanne under specific criteria. A copy of the contract between the Federal Office of Statistics and the University Hospital of Lausanne regarding data provision, security, and use can be provided upon justified request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2022. Available online: https://ginasthma.org/ (accessed on 18 January 2023).
  2. Tello, J.; Satylganova, A.; Barbazza, E. Assessing Health Services Delivery Performance with Hospitalizations for Ambulatory Care Sensitive Conditions; WHO: Rome, Italy, 2016. [Google Scholar]
  3. WHO. Chronic Obstructive Pulmonary Disease (COPD). 2023. Available online: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) (accessed on 25 December 2022).
  4. Celli, B.R.; Wedzicha, J.A. Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease. N. Engl. J. Med. 2019, 381, 1257–1266. [Google Scholar] [CrossRef] [PubMed]
  5. Criner, R.N.; Han, M.K. COPD Care in the 21st Century: A Public Health Priority. Respir. Care 2018, 63, 591–600. [Google Scholar] [CrossRef] [PubMed]
  6. Singh, D.; Agusti, A.; Anzueto, A.; Barnes, P.J.; Bourbeau, J.; Celli, B.R.; Criner, G.J.; Frith, P.; Halpin, D.M.G.; Han, M.; et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD science committee report 2019. Eur. Respir. J. 2019, 53, 1900164. [Google Scholar] [CrossRef] [PubMed]
  7. De Pietro, C.; Camenzind, P.; Sturny, I.; Crivelli, L.; Edwards-Garavoglia, S.; Spranger, A.; Wittenbecher, F.; Quentin, W. Switzerland: Health System Review. Health Syst. Transit. 2015, 17, 1–288. [Google Scholar]
  8. Federal Office of Public Health. Key Figures for Swiss Hospitals. Available online: https://www.bag.admin.ch/bag/en/home/zahlen-und-statistiken/zahlen-fakten-zu-spitaelern/kennzahlen-der-schweizer-spitaeler.html (accessed on 11 April 2023).
  9. Cohidon, C.; Cornuz, J.; Senn, N. Primary care in Switzerland: Evolution of physicians’ profile and activities in twenty years (1993–2012). BMC Fam. Pr. 2015, 16, 107. [Google Scholar] [CrossRef]
  10. Rosano, A.; Loha, C.A.; Falvo, R.; Van Der Zee, J.; Ricciardi, W.; Guasticchi, G.; De Belvis, A.G. The relationship between avoidable hospitalization and accessibility to primary care: A systematic review. Eur. J. Public Health 2012, 23, 356–360. [Google Scholar] [CrossRef]
  11. Cartier, T.; Naiditch, M.; Lombrail, P. Avoidable Hospitalizations: The Sole Responsibility of Primary Care? Rev. Epidemiol. Sante Publ. 2014, 62, 225–236. [Google Scholar] [CrossRef]
  12. OECD. Stat. Health Care Quality Indicators. Available online: https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_HCQI (accessed on 8 January 2023).
  13. OECD. Health Care Quality and Outcomes Indicators. Available online: https://www.oecd.org/health/health-care-quality-outcomes-indicators.htm (accessed on 15 April 2023).
  14. OECD. Health Care Quality and Outcomes (HCQO) 2020–2021 Indicator Definitions. Available online: http://www.oecd.org/els/health-systems/Definitions-of-Health-Care-Quality-Outcomes.pdf (accessed on 8 January 2023).
  15. Eggli, Y.; Desquins, B.; Seker, E.; Halfon, P. Comparing potentially avoidable hospitalization rates related to ambulatory care sensitive conditions in Switzerland: The need to refine the definition of health conditions and to adjust for population health status. BMC Health Serv. Res. 2014, 14, 25. [Google Scholar] [CrossRef]
  16. Berlin, C.; Busato, A.; Rosemann, T.; Djalali, S.; Maessen, M. Avoidable hospitalizations in Switzerland: A small area analysis on regional variation, density of physicians, hospital supply and rurality. BMC Health Serv. Res. 2014, 14, 289. [Google Scholar] [CrossRef]
  17. Gygli, N.; Zúñiga, F.; Simon, M. Regional variation of potentially avoidable hospitalisations in Switzerland: An observational study. BMC Health Serv. Res. 2021, 21, 849. [Google Scholar] [CrossRef]
  18. WHO. International Statistical Classification of Diseases and Related Health Problems (ICD). Available online: https://www.who.int/standards/classifications/classification-of-diseases (accessed on 8 January 2023).
  19. OFS. Classification Suisse des Interventions Chirurgicales (CHOP). Available online: https://www.bfs.admin.ch/bfs/fr/home/statistiques/sante/nomenclatures/medkk/instruments-codage-medical.assetdetail.5808564.html (accessed on 8 January 2023).
  20. OECD. Length of Hospital Stay (Indication). Available online: https://data.oecd.org/healthcare/length-of-hospital-stay.htm (accessed on 15 April 2023).
  21. Halfon, P.; Eggli, Y.; van Melle, G.; Chevalier, J.; Wasserfallen, J.-B.; Burnand, B. Measuring potentially avoidable hospital readmissions. J. Clin. Epidemiol. 2002, 55, 573–587. [Google Scholar] [CrossRef] [PubMed]
  22. Deyo, R.A.; Cherkin, D.C.; Ciol, M.A. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J. Clin. Epidemiol. 1992, 45, 613–619. [Google Scholar] [CrossRef] [PubMed]
  23. Charlson, M.E.; Pompei, P.; Ales, K.L.; MacKenzie, C.R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 1987, 40, 373–383. [Google Scholar] [CrossRef]
  24. Federal Act on Research Involving Human Beings (HRA) of 30 September 2011 (Status as of 1 December 2022), Article 2 Paragraph 2c). Available online: https://www.fedlex.admin.ch/eli/cc/2013/617/en (accessed on 8 January 2023).
  25. OECD. Health at a Glance 2021: OECD Indicators. Available online: https://www.oecd-ilibrary.org/sites/eeeae3eb-en/index.html?itemId=/content/component/eeeae3eb-en (accessed on 8 January 2023).
  26. Chowdhury, N.U.; Guntur, V.P.; Newcomb, D.C.; Wechsler, M.E. Sex and gender in asthma. Eur. Respir. Rev. 2021, 30, 210067. [Google Scholar] [CrossRef]
  27. Federal Statistical Office. Portraits of the Cantons. Available online: https://www.bfs.admin.ch/bfs/en/home/statistics/regional-statistics/regional-portraits-key-figures/cantons.html (accessed on 16 March 2023).
  28. Ntritsos, G.; Franek, J.; Belbasis, L.; Christou, M.A.; Markozannes, G.; Altman, P.; Fogel, R.; Sayre, T.; Ntzani, E.E.; Evangelou, E. Gender-specific estimates of COPD prevalence: A systematic review and meta-analysis. Int. J. Chronic Obstr. Pulm. Dis. 2018, 13, 1507–1514. [Google Scholar] [CrossRef] [PubMed]
  29. Spycher, J.; Morisod, K.; Eggli, Y.; Moschetti, K.; Le Pogam, M.-A.; Peytremann-Bridevaux, I.; Bodenmann, P.; Marti, J.; Indicators on Healthcare Equity in Switzerland. New Evidence and Challenges. Report Commissioned by the Federal Office of Public Health. Bern: FOPH. 2021. Available online: https://www.bag.admin.ch/dam/bag/de/dokumente/nat-gesundheitsstrategien/nat-programm-migration-und-gesundheit/chancengleich-heit-in-der-gesundheitsversorgung/report-indicators-on-healthcare-equity.pdf.download.pdf/Bericht%20Indicators%20on%20Healthcare%20Equity.pdf (accessed on 16 March 2023).
  30. Dantas, I.; Santana, R.; Sarmento, J.; Aguiar, P. The impact of multiple chronic diseases on hospitalizations for ambulatory care sensitive conditions. BMC Health Serv. Res. 2016, 16, 348. [Google Scholar] [CrossRef] [PubMed]
  31. O’Malley, A.S.; Pharm, H.H.; Schrag, D.; Wu, B.; Bach, P.B. Potentially avoidable hospitalizations for COPD and pneumonia: The role of physician and practice characteristics. Med. Care 2007, 45, 562–570. [Google Scholar] [CrossRef]
  32. van Loenen, T.; van den Berg, M.; Westert, G.P.; Faber, M.J. Organizational aspects of primary care related to avoidable hospitalization: A systematic review. Fam. Pract. 2014, 31, 502–516. [Google Scholar] [CrossRef]
  33. OFSP. Influenza—Résultats de Laboratoire à Déclaration Obligatoire. Available online: https://www.bag.admin.ch/bag/fr/home/zahlen-und-statistiken/zahlen-zu-infektionskrankheiten/meldepflichtige-infektionskrankheiten—Woechentliche-fallzahlen.html (accessed on 7 March 2023).
  34. Paul, M.C.; Dik, J.-W.H.; Hoekstra, T.; Van Dijk, C.E. Admissions for ambulatory care sensitive conditions: A national observational study in the general and COPD population. Eur. J. Public Health 2019, 29, 213–219. [Google Scholar] [CrossRef]
  35. Sharma, N.; Schwendimann, R.; Endrich, O.; Ausserhofer, D.; Simon, M. Variation of Daily Care Demand in Swiss General Hospitals: Longitudinal Study on Capacity Utilization, Patient Turnover and Clinical Complexity Levels. J. Med. Internet Res. 2021, 23, e27163. [Google Scholar] [CrossRef]
  36. Swiss Health Observatory (Obsan). Available online: https://ind.obsan.admin.ch/en/indicator/monam/expenditure-on-prevention-and-health-promotion-by-service (accessed on 16 March 2023).
  37. Gusmano, M.K.; Rodwin, V.G.; Weisz, D. A new way to compare health systems: Avoidable hospital conditions in manhattan And Paris. Health Aff. 2006, 25, 510–520. [Google Scholar] [CrossRef] [PubMed]
  38. Eggli, Y.; Halfon, P.; Piaget-Rossel, R.; Bischoff, T. Measuring medically unjustified hospitalizations in Switzerland. BMC Health Serv. Res. 2022, 22, 158. [Google Scholar] [CrossRef] [PubMed]
Healthcare 11 01229 g001 550
Figure 1. Evolution of the standardized rates of potentially avoidable hospitalizations for asthma in Switzerland, 1998–2018.
Figure 1. Evolution of the standardized rates of potentially avoidable hospitalizations for asthma in Switzerland, 1998–2018.
Healthcare 11 01229 g001
Healthcare 11 01229 g002 550
Figure 2. Evolution of the standardized rates of potentially avoidable hospitalizations for chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
Figure 2. Evolution of the standardized rates of potentially avoidable hospitalizations for chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
Healthcare 11 01229 g002
Healthcare 11 01229 g003 550
Figure 3. Number of days of potentially avoidable hospitalizations for asthma in Switzerland, 1998–2018.
Figure 3. Number of days of potentially avoidable hospitalizations for asthma in Switzerland, 1998–2018.
Healthcare 11 01229 g003
Healthcare 11 01229 g004 550
Figure 4. Number of days of potentially avoidable hospitalizations for chronic obstructive pulmonary disease in Switzerland, 1998–2018.
Figure 4. Number of days of potentially avoidable hospitalizations for chronic obstructive pulmonary disease in Switzerland, 1998–2018.
Healthcare 11 01229 g004
Table
Table 1. Main characteristics of potentially avoidable hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
Table 1. Main characteristics of potentially avoidable hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
CharacteristicsAsthmaCOPD
N25,260135,069
Women (%)16,694 (66.1)57,341 (42.5)
Age groups (%)
[20, 30]2720 (10.8)454 (0.3)
[30, 40]3146 (12.5)1115 (0.8)
[40, 50]3894 (15.4)4254 (3.2)
[50, 60]3912 (15.5)15,527 (11.5)
[60, 70]3671 (14.5)33,956 (25.1)
[70, 80]4247 (16.8)47,337 (35.1)
[80, 90]3140 (12.4)29,011 (21.5)
[90, ∞]530 (2.1)3415 (2.5)
Swiss nationality (%)19,076 (75.5)116,881 (86.5)
Region (%)
Leman6015 (23.8)24,824 (18.4)
Mittelland4915 (19.5)26,185 (19.4)
Northwest4440 (17.6)25,285 (18.7)
Zurich3435 (13.6)22,192 (16.4)
Eastern3110 (12.3)17,170 (12.7)
Central1702 (6.7)9795 (7.3)
Ticino1643 (6.5)9618 (7.1)
Compulsory insurance (%)24,148 (95.6)132,284 (97.9)
Emergency admission (%)19,775 (78.3)99,586 (73.7)
Patient’s decision to access healthcare (%)9537 (37.8)31,682 (23.5)
Charlson’s index categories (%)
0–118,487 (73.2)5750 (4.3)
2–35729 (22.7)95,240 (70.5)
≥41044 (4.1)34,079 (25.2)
Table
Table 2. Number and EU-standardized rate (per 100,000 people) of potentially avoidable hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
Table 2. Number and EU-standardized rate (per 100,000 people) of potentially avoidable hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
AsthmaCOPD
YearNumberRateNumberRate
199886417.17350177.4
1999114422.26445397.0
2000128524.954986107.4
2001128224.215048106.3
2002120622.845185107.6
2003118321.635514112.6
2004130923.655469109.6
2005118621.346188121.8
2006103718.325880113.7
2007120620.846758128.3
2008114819.616114113.4
2009121620.586135111.6
2010112618.766284112.3
2011114518.596483113.9
2012114118.236963119.9
2013129120.537599128.0
2014124419.427579125.1
2015124019.038197132.9
2016134020.248306132.1
2017129219.369114142.5
2018137520.369313142.7
Table
Table 3. Number of days and beds occupied for potentially avoidable hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
Table 3. Number of days and beds occupied for potentially avoidable hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) in Switzerland, 1998–2018.
AsthmaCOPD
YearDaysOccupied BedsDaysOccupied Beds
199810,5902952,529 144
199913,0643667,929 186
200014,1733971,776 197
200112,7833573,314 201
200211,6373272,122 198
200310,7102972,815 199
200411,6793270,976 194
200598432774,855 205
200675762171,035 195
200783852379,741 218
200881822269,223 190
200993872668,297 187
201083432368,116 187
201181542269,871 191
201277492173,942 203
201391562578,940 216
201487172479,872 219
201576892174,155 203
201682712375,425 207
201777102183,794 230
201882002284,863 233
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Gouveia, A.; Mauron, C.; Marques-Vidal, P. Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study. Healthcare 2023, 11, 1229. https://doi.org/10.3390/healthcare11091229

AMA Style

Gouveia A, Mauron C, Marques-Vidal P. Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study. Healthcare. 2023; 11(9):1229. https://doi.org/10.3390/healthcare11091229

Chicago/Turabian Style

Gouveia, Alexandre, Charlène Mauron, and Pedro Marques-Vidal. 2023. "Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study" Healthcare 11, no. 9: 1229. https://doi.org/10.3390/healthcare11091229

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop