First Nations’ hospital readmission ending in death: a potential sentinel indicator of inequity?

• Published in: International Journal of Circumpolar Health
• Main Authors: Josée Lavoie, Wanda Phillips-Beck, Kathi Avery Kinew, Grace Kyoon-Achan, Alan Katz
• Format: Article in Journal/Newspaper
• Language: English
• Published: Taylor & Francis Group 2021
• Subjects: ambulatory care sensitive conditions; equity; indigenous; first nations; primary health care; Arctic medicine. Tropical medicine; RC955-962; Arctic; Circumpolar Health; First Nations; International Journal of Circumpolar Health
• Online Access: https://doi.org/10.1080/22423982.2020.1859824; https://doaj.org/article/e474a0d1da3642f4bdb01d7b26a28224

In this study, we focused on readmissions for Ambulatory Care Sensitive Conditions (ACSC) ending in death, to capture those admissions and readmissions that might have been prevented if responsive primary healthcare was accessible. We propose this as a sentinel indicator of equity. We conducted analyses of Manitoba-based 30-day hospital readmission rates for ACSC which resulted in death, using data from 1986-2016 adjusted for age, sex, and socio-economic status. Our findings show that, across Manitoba, overall rates of readmissions ending in death are slowly increasing, and increasing more dramatically among northern First Nations, larger First Nations not affiliated with Tribal Councils, and in the western region of the province. These regions have continuously been highlighted as disadvantaged in terms of access to care, suggesting that the time for action is overdue. Rising rates of readmissions for ACSC ending in death suggest that greater attention should be placed on access to responsive primary healthcare. These findings have broader implications for territorial healthcare systems which purchase acute care services from provinces south of them. As an indicator of quality, monitoring readmissions ending in death could provide territorial governments insights into the quality of care provided to their constituents by provincial authorities.