Abstract:
The main purpose of this study was to examine empirically the trends and reasons for rising
acute adult medical admissions at two major public hospitals in Auckland from 1997 to 2004.
According to recent national and international literature published on the topic, there has been
unsustainable growth in the adult medical admissions both in NZ and most of the other
developed countries. Overall, the causes of this increase have not been explored sufficiently
in the literature reviewed. The NZ research has largely focused on the macro-analysis of
hospital throughput data from health policy points of view.
Methodology: A mixed methodology research design was applied to address the problem.
Phase 1 quantitatively analysed adult medical hospital admission data (N = 277,416) obtained
from the two hospitals (Middlemore and Auckland Public Hospitals), and phase 2
qualitatively explored the responses and views of the health professional expert panel (n = 16)
in relation to the findings of phase 1 of the study.
Findings: Overall, the crude number of admissions and age-standardised admission rates at
both hospitals increased more rapidly than actual population increases. Approximately 1/3 of
the patients accounted for 2/3 of the total admissions. Five major diagnostic categories
accounted for 70%-80% of total acute admissions, with circulatory and respiratory system
disorders being the leading causes of medical admissions. There was a strong relationship
between age and increased admissions. MMH hospital overall, and its ethnic groups
separately, had significantly higher admission rates than APH. Comparison of ethnic groups
highlighted significant variations in the admission rates at the two hospitals despite adjusting
for age, morbidity and deprivation.
Conclusions: Overall the increase and variation in admission rates between the hospitals and
ethnic groups was dependent on factors such as the characteristics of the population and
patients, hospital admission and administration processes, availability of hospital beds,
medical management at the hospital, and availability of primary and community care services.
By making changes to those factors in the control of hospitals and District Health Boards,
hospitals can potentially influence the trajectory of rising medical admissions. These factors
include systems for managing patients with chronic illness, and pathways from community
services to hospital. Finally, a number of future research areas, such as a large-scale study to
explore the health service utilisation of the 55+ age groups, have been proposed.