Variation in general practice medical admission rates for elderly people

Background Emergency medical admissions are rising, particularly in the eld erly. Variation in admission rates between general practices has received l ittle attention, and requires explanation. Methods A retrospective review was carried out of emergency medical admissi ons to the District General Hospital (DGH) and the Community Hospitals (CHs ) in West Gloucestershire in subjects over 75 years of age during 3 years. A survey of general practitioner (GP) attitudes to emergency admissions was carried out. Results A five-fold spread in DGH and CH admission rates for elderly medica l emergencies was found, and a three-fold spread of overall admission rates . Rates were consistent within a practice each year. The spreads of practic e mortality rates and myocardial infarction admission rates were smaller. T he variation between practices was not explained by the Jarman index or by attitudes identified in GPs. Practices with high admission rates had slight er higher annual hospital mortality rates, but lower episode fatality rates . Conclusion Admission rates show considerable variation between practices, w hich is only partly explained by morbidity rates, and consistency over 3 ye ars.