Abstract
ObjectivesTo estimate and identify the variations in rates of Avoidable Hospitalization for Ambulatory Care Sensitive Conditions (AH-ACSC) in public institutions of the Mexican health system during the period 2010–2017.MethodsSecondary analysis of the hospital discharge database of the Ministry of Health (MoH) from 2010 to 2017. AH for ACSC was calculated by age group and sex per 100,000. Variations per year between institutions were calculated with the extreme quotient (EQ), coefficient of variation (CV) and systematic component of variance (SCV). Adjusted AH rates were calculated by group of causes (acute, chronic and preventable by vaccination). Adjusted AH trend rates were analyzed by Join Point Regression.ResultsFor the period 2010–2017, the number of AH for ACSC decreased from 676,705 to 612,897, going from almost 13% to 10.7% of hospital discharges. There is consistency in terms of relative variance magnitude. But, with regards to SCV, the change remained constant, and in a second period of 2015–2017, high variation was observed by SCV ≥ 3. All-cause AH is diminishing in all institutions. AH rates for diabetes are the highest, but like other chronic diseases, there was a decline in the period from 2010 to 2017. The relative reduction varied from 15% for heart failure to 38% for complications from diabetes or hypertension, to 75% for angina.ConclusionsAH for ACSC is an indirect indicator of quality and access to first-level care. Variations by institutions are observed. This variation in CV and SCV across subsystems and states may be due to inequities in the provision of services. The factors that contribute to the burden of AH for ACSC in the Mexican Health System require detailed analysis.
Highlights
The efficiency and effectiveness of health systems has been a priority for all countries, and one of the challenges in health policy
Those diseases sensitive to prevention, diagnosis and treatment on an outpatient basis, which can be adequately and timely attended at the first level of care, such as acute conditions, which could be preventable, if timely access and provision of services is guaranteed on an outpatient basis, and, in the case of certain chronic diseases such as diabetes mellitus and hypertension, surveillance and control at the primary care could prevent complications caused by hospitalization [2]
Weissman [3], from a panel of experts, defined a list of 12 ambulatory care-sensitive conditions (ACSC), which has been used by many authors, Gusmano [4] among others, whose study compared the differences in Avoidable hospitalizations (AH) for ACSC in large cities, using it as an indicator of equity and efficiency of the health system, and as an indicator of access to primary care [4]
Summary
The efficiency and effectiveness of health systems has been a priority for all countries, and one of the challenges in health policy This has focused on the need of developing indicators of health system performance, as well as specific indicators of quality of care at the different levels. ACSC has been defined as those “conditions where good outpatient care can potentially prevent the need for hospitalization” [1] That is, those diseases sensitive to prevention, diagnosis and treatment on an outpatient basis, which can be adequately and timely attended at the first level of care, such as acute conditions, which could be preventable, if timely access and provision of services is guaranteed on an outpatient basis, and, in the case of certain chronic diseases such as diabetes mellitus and hypertension, surveillance and control at the primary care could prevent complications caused by hospitalization [2]. Various authors have used these proposals as a starting point to define by consensus the most appropriate codes according to their context, and some have considered the importance of defining categories that group codes, considering whether it is an acute, chronic or preventable condition [6, 7]
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