Complex community health and social care interventions - Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review.

Preventing hospitalizations due to ambulatory care sensitive conditions (ACSCs) is traditionally the responsibility of primary care. The determinants of ACSC hospitalizations, however, are not purely medical, but also influenced by other factors like patients' social and personal circumstances. Interventions that include or consist entirely of community health services and social care could potentially reduce the ACSC hospitalization rate. Comparisons of the features of successful interventions of this nature, however, are still lacking. We therefore conducted a systematic review of the literature to identify out-of-hospital interventions that (a) included aspects or consisted entirely of community health services and social care and (b) analyzed the ACSC hospitalization rate as an outcome measure. We identified papers reporting the results of 32 interventions and extracted structural and behavioral features to determine which of these were shared by most or all of the successful interventions. We found that all of the successful interventions included a primary care physician and provided care management. Moreover, most of the successful interventions were characterized by a high degree of interconnectedness between professional groups and provided care within so-called health care homes. We also identified a set of care coordination activities that were implemented in most of the successful interventions. Policy makers may wish to consider adopting these features when designing interventions that aim to reduce the ACSC hospitalization rate.

Validation and application of a needs-based segmentation tool for cross-country comparisons.

OBJECTIVE: To compare countries' health care needs by segmenting populations into a set of needs-based health states. DATA SOURCES: We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. STUDY DESIGN: We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death. DATA COLLECTION/EXTRACTION METHODS: We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories. PRINCIPAL FINDINGS: The CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors. CONCLUSIONS: The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.