Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia.

Eduardo Low Padilla,Mario Arturo Isaza Ruget,Sandra Yadira Moreno Marín,Claudia Carolina Colmenares Mejía,Abel E González-Vélez,Paola Andrea Rengifo Bobadilla,Juan Pablo Rueda Sánchez

doi:10.11606/s1518-8787.2019053000563

Abstract

ABSTRACTOBJECTIVE To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System.METHODS A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources.RESULTS There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval.CONCLUSIONS A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.

Highlights

In order to promote equity and cost effectiveness in the provision of health services, Colombia adopted in 2011 the primary health care strategy as part of the health system reform[1]
The Entidad Promotora de Salud (EPS) Sanitas implemented a care model based on primary care units (PCU), which has a gatekeeping function and where activities of induced demand for maintenance of health and identification of specific risks are developed
Programs for management of diseases such as hypertension, diabetes, chronic obstructive pulmonary disease and other conditions are implemented in the PCU, through which EPS carries out prevention, diagnosis, treatment, rehabilitation and follow-up in the insured population[3]

Summary

Introduction

In order to promote equity and cost effectiveness in the provision of health services, Colombia adopted in 2011 the primary health care strategy as part of the health system reform[1] In this reform, the Colombian state transfers ex-ante management of health risks to insurance companies, beyond the contingency of the disease[2]. The analysis of ambulatory care sensitive conditions (ACSC) has been regarded as an indicator of primary care performance This indicator has been used as a proxy measure for potentially preventable admission due to acute and chronic diseases[4,5,6]. High hospitalization rates for different ACSC may indicate poor quality of care at the primary care level[7,8,9] This evaluation allows to identify individuals for targeting of interventions to reduce preventable admissions[10,11]

Methods

Results

Conclusion