Is greater integration associated with larger reductions in unplanned hospital admissions? An analysis of new care models in England

Abstract: Integrated primary and acute care systems (PACS) aims to break down the traditional barriers between health and care organisations to establish more personalised and coordinated health services for patients and in particular reduce the use of hospital emergency services. We examine whether greater integration between primary and secondary care is the causal mechanism through which PACS affect emergency admissions for chronic ambulatory care sensitive conditions (ACSAs) amongst older adults using causal mediation analysis. The sign of the mediated effect is in line with our expectations, but is not statistically significant. However, we find evidence to suggest a mediated effect of the integration of primary and secondary care on the relationship between one PACS and unplanned hospital admissions, although in the opposite direction as hypothesised. Our evidence does not support the hypothesised causal mechanism that PACS increase integration of care and that through higher integration preventable hospital care will be reduced.