Factors related to avoidable hospitalization of elderly with chronic obstructive pulmonary disease or heart disease at the first admission

Background: Ambulatory care sensitive conditions (ACSCs) are defined as conditions that hospitalizations can be prevented if appropriate and prompt primary care is provided. In Hong Kong, over 50% of the bed-days are consumed by elderly at the age of 65 and above, and the rate of ACSC admission was higher compared to other developed countries. Sparse research has been done on hospital utilization of the elderly. Information on what factors may lead to avoidable hospitalization remains unknown. According to hospital discharge data, chronic obstructive pulmonary disease (COPD) and heart disease (HD) rank the most frequently occurring discharge diagnoses among ACSCs. Methods: A nested case control study using a telephone interview with a structured questionnaire was used for 418 older people (203 cases vs. 215 controls) recruited from the Elderly Health Centre cohort. The conceptual framework drew on the Andersen Behavior Model to facilitate understanding of factors that may lead to first avoidable hospital admission, including demographic characteristics, health conditions and ambulatory health service utilization. Results: Living alone (OR adjusted =2.09 CI=1.12, 3. 89) was associated with first avoidable hospitalization. Frequency of doctor visits was also associated with hospital admissions. Older people who regularly visited specialist outpatient clinics or accident and emergency departments as their first choice for health service were more likely to be admitted. Self-reported health status was not associated with hospital admission. Discussion: The findings suggest that living alone is an important predictor of new avoidable hospitalization of the elderly with chronic obstructive pulmonary disease or heart disease.