Inequalities in unplanned hospital admission and the role of continuity of care.

Study type
Date of Approval
Study reference ID
Lay Summary

Having an unplanned hospital admission can be an unpleasant experience and is sometimes avoidable. The number of people experiencing unplanned hospital admission is increasing and the chance of an unplanned admission is higher for certain groups. For example, people living in socioeconomically deprived circumstances have a higher chance of experiencing an unplanned hospital admission and are more likely to spend longer in hospital.

There may be factors within primary care that can help reduce unplanned admissions. Seeing the same general practitioner (GP) over time allows the relationship between patient and GP to develop. This is known as continuity of care. Patients with higher continuity of care have fewer unplanned admissions, lower mortality rate and overall report better patient experience. This may be particularly helpful for people with complex health needs such as those managing multiple long-term conditions, or people juggling complex social needs such as those living in socially deprived areas. We know that people living in areas of deprivation tend to have more difficulty seeing a GP (in part because there are fewer available GPs) and they have lower continuity of care.

This study uses health care records to understand if there are inequalities in experiencing an unplanned hospital admission, and whether low continuity of care helps explains these inequalities. This will show whether more resources to improve continuity of care are needed in certain kinds of areas. This could help healthcare leads to target resources and ultimately contribute to avoiding some unplanned hospital admissions in more deprived areas.

Technical Summary

Unplanned hospital admissions have increased in the last 10 years and certain groups are at higher risk of these admissions, such as people with multiple long-term conditions and people experiencing socioeconomic deprivation. Low continuity of care in primary care is also associated with higher risk of unplanned hospital admissions. Improving continuity overall and in specific groups may contribute to avoiding unplanned admissions and reducing inequalities in unplanned admissions.

This study uses a random sample of adults from CPRD to: describe both continuity of care and unplanned hospital care across levels of deprivation; describe the association between continuity of care and unplanned hospital care; and examine whether continuity of care helps explain inequalities in risk of unplanned hospital care.

This information will be used to increase our understanding of the value of continuity of care for patients and for use of healthcare, and to advocate for resources to improve continuity.

This observational follow up study uses CPRD data from 2017-2018, linked Index of Multiple Deprivation (IMD) data, and linked Hospital Episode Statistics from 2019 (Admitted Patient Care and Accident and Emergency).

Risk of unplanned hospital admissions (all-cause and for ambulatory care sensitive conditions), length of unplanned hospital admission (all-cause and ambulatory care sensitive conditions), and risk of accident and emergency visit will be estimated using a series of multilevel linear and logistic regression models. Models will be sequentially adjusted for i) sex, age, total number of consultations and length of follow up, ii) IMD decile, and iii) number of long-term conditions. We will also explore the possible mediating influence of continuity of care on inequalities in unplanned hospital care. All models will include random effects to allow for clustering at practice level.

Health Outcomes to be Measured

Outcomes of interest will be derived from CPRD and linked Hospital Episode Statistics (HES) data.

The primary outcome is all-cause unplanned hospital admissions.

Secondary outcomes are:

• unplanned hospital admissions for ambulatory care sensitive conditions

• length of stay for all-cause unplanned hospital admissions

• length of stay for ambulatory care sensitive conditions

• visits to the Accident and Emergency Department


Anne Alarilla - Chief Investigator - The Health Foundation
Andrew Campbell - Corresponding Applicant - The Health Foundation
Anna Powell - Collaborator - The Health Foundation
George Stevenson - Collaborator - The Health Foundation
Jay Hughes - Collaborator - The Health Foundation
Mai Stafford - Collaborator - The Health Foundation


HES Accident and Emergency;HES Admitted Patient Care;Patient Level Index of Multiple Deprivation