Description
The discrepancy between demand for medical attention and the capacity of hospitals to provide it result in overcrowding and ultimately create an access block to hospital care. Although various initiatives have been implemented, such as optimising hospital resources in a particular geographical area through clustering, enhancing efficiency in the process of care in hospitals, as well as redirecting non-emergency patients to Klinik Kesihatan, little has been done to look at reducing the demand for hospital care. As such, exploration of avoidable hospitalisations is the first step to identify target population that can benefit from improvement in disease care management and subsequently reduce demand in hospital care. This study aims to describe hospitalisations due to chronic ambulatory care sensitive conditions (ACSCs) and explore ambulatory healthcare providers' perspectives on avoidable hospitalisation through a mixed-method approach. In Part 1, a literature review and expert opinion session will be conducted to derive the list of chronic ACSCs pertinent to the Malaysian context. Based on this list, data from the Malaysian Health Data Warehouse (myHDW) will be used to describe ACSCs in Malaysia, cost of avoidable hospitalisations in public hospitals, as well as sociodemographic and geographic inequalities in magnitude and type of ACSCs. Data cleaning and analysis will be conducted using Python. Following Part 1, stakeholders will identify ACSCs that will be prioritised for the conduct of Part 2. Results from Part 1 will determine the sample for ambulatory healthcare providers that will be invited as participants. Data collection will be through focus group discussions (FGD) at hospitals that have high or low volume of ACSCs and proportion of ACSCs-related admissions. Participants who are not able to participate in FGDs will be approached for in depth interviews (IDI). A question guide will be used in the conduct of the qualitative study. Data will be analysed using thematic analysis. To supplement Part 2 qualitative results, a literature review on the systems strategies used by other countries or agencies to address avoidable hospitalisations will be conducted. The entire study will be conducted from September 2023 - September 2025.