The devil is in the details: trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000Reportar como inadecuado

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BMC Health Services Research

, 6:104

First Online: 16 August 2006Received: 28 April 2006Accepted: 16 August 2006DOI: 10.1186-1472-6963-6-104

Cite this article as: Cloutier-Fisher, D., Penning, M.J., Zheng, C. et al. BMC Health Serv Res 2006 6: 104. doi:10.1186-1472-6963-6-104


BackgroundResearchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates AHRs during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province.

MethodsAnalyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data.

ResultsGenerally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year i.e. around 95% with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning.

ConclusionThese data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas under recent health sector restructuring initiatives. It remains important to continue to monitor the discrepancy between them as a reflection of inequity in service provision. In addition, it is important to consider alternative explanations for the observed trends paying particular attention to the needs of rural and urban populations and the factors influencing local service provision.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-6-104 contains supplementary material, which is available to authorized users.

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Autor: Denise Cloutier-Fisher - Margaret J Penning - Chi Zheng - Eric-Bené F Druyts


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