Variation in non-elective hospital admission and consequent asthma costs across primary care practice and clinical commissioning group (CCG), Wessex, United Kingdom

Asthma control remains a challenge in the UK with hospital admissions reflecting a subset of the population at risk of life threatening asthma. Understanding the uniformity of hospital admissions is the first step towards ensuring most effective clinical resource allocation. We combined Hospital Episode Statistics (HES) data and Quality and Outcomes Framework (QOF) Registry data to analyse the hospital admission rates for asthma patients across the UK region of Wessex (April 2013 to March 2014). HES and QOF data was available for 309 Primary Care Practices and all 9 Clinical Commissioning Groups (CCGs). We compared the average inpatient spend and length of stay for a primary diagnosis of asthma per diagnosed asthma patient from the QOF registry at Practice and CCG level. At CCG level there is a 2.8 fold difference in the inpatient admission rates (by spell) per 1000 of the diagnosed asthmatic population. This represents double the cost per patient to the CCG, from £10.48 to £20.59 per diagnosed asthmatic, a potential saving to the highest admitting CCG of over £160,000. Length of stay varied from 1.8 to 5.0 days per CCG and interestingly, did not appear to correspond to 30 day readmission rates. At GP practice level admission costs for asthmatics ranged widely, with a 17-fold difference in spending per diagnosed asthmatic, from the lowest-spend 10% of practices to the highest-spend 10% of practices (32 practices, mean £3-£53/asthmatic). Whilst there will always be confounding factors in large datasets such as this, these numbers suggest potential areas to target for clinical gain and potential cost savings.