Analysis of trends and reasons for rising acute medical admissions in Auckland's public hospitals

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dc.contributor.advisor Associate Professor Dr Nicola North en
dc.contributor.advisor Emeritus Professor Dr Norman Sharpe en Benipal, Jagpal Singh en 2008-03-12T20:32:26Z en 2008-03-12T20:32:26Z en 2008 en
dc.identifier.citation Thesis (PhD--Nursing)--University of Auckland, 2007. en
dc.identifier.uri en
dc.description.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. en
dc.format Scanned from print thesis en
dc.language.iso en en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA1787998 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. en
dc.rights.uri en
dc.title Analysis of trends and reasons for rising acute medical admissions in Auckland's public hospitals en
dc.type Thesis en Nursing en The University of Auckland en Doctoral en PhD en
dc.subject.marsden Fields of Research::320000 Medical and Health Sciences::321200 Public Health and Health Services en
dc.rights.holder Copyright: The author en
pubs.local.anzsrc 11 - Medical and Health Sciences en Faculty of Medical & Hlth Sci en

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