The strongest risk factors for avoidable hospital admission are age and
deprivation but ethnicity, distance to hospital, rurality, lifestyle and meteorological
factors are also important, as well as access to primary care. There is still
considerable uncertainty around which admissions are avoidable. In terms of
services to reduce admissions there is evidence of effectiveness for education, selfmanagement,
exercise and rehabilitation, and telemedicine in certain patient
populations, mainly respiratory and cardiovascular. Specialist heart failure services
and end-of-life care also reduce these admissions. However, case management,
specialist clinics, care pathways and guidelines, medication reviews, vaccine
programmes and hospital at home do not appear to reduce avoidable admissions.
There is insufficient evidence on the role of combinations or coordinated systemwide
care services, emergency department interventions, continuity of care, home
visits or pay-by-performance schemes. This highlights the importance of robust
evaluation of services as they are introduced into health and social care systems.
