Comparison and Impact of Four Different Methodologies for Identification of Ambulatory Care Sensitive Conditions.

Andreia Pinto,Alberto Freitas,Cristina Costa Santos,João Vasco Santos,Júlio Souza,Mariana Lobo,João Viana

doi:10.3390/ijerph17218121

Abstract

Ambulatory care sensitive conditions (ACSCs) are conditions for which hospitalizations are thought to be avoidable if effective and accessible primary health care is available. However, to define which conditions are considered ACSCs, there is a considerable number of different lists. Our aim was to compare the impact of using different ACSC lists considering mainland Portugal hospitalizations. A retrospective study with inpatient data from Portuguese public hospital discharges between 2011 and 2015 was conducted. Four ACSC list sources were considered: Agency for Healthcare Research and Quality (AHRQ), Canadian Institute for Health Information (CIHI), the Victorian Ambulatory Care Sensitive Conditions study, and Sarmento et al. Age–sex-adjusted rates of ACSCs were calculated by district (hospitalizations per 100,000 inhabitants). Spearman’s rho, the intraclass correlation coefficient (ICC), the information-based measure of disagreement (IBMD), and Bland and Altman plots were computed. Results showed that by applying the four lists, different age–sex-adjusted rates are obtained. However, the lists that seemed to demonstrate greater agreement and consistency were the list proposed by Sarmento et al. compared to AHRQ and the AHRQ method compared to the Victorian list. It is important to state that we should compare comparable indicators and ACSC lists cannot be used interchangeably.

Highlights

Ambulatory care sensitive conditions (ACSCs) are conditions that can be typically managed at the first level of health care and for which hospitalizations can be potentially avoidable, in the sense that effective primary health care should provide an early diagnosis and proper management of chronic diseases, reducing the risk of hospitalization [1,2,3].The determination of hospital admission rates for ACSCs has been increasingly used as an indicator to measure the quality and accessibility of primary health care [4,5,6]
In some European countries, where access to primary health care (PHC) is universal, the concept of ACSCs is mostly applied to evaluate the quality of primary care, as it happens in Portugal, rather than to evaluate accessibility [10], which is
We identified that the AHRQ, the Victorian study, and Sarmento et al methods showed avoidable hospitalization rates that were more similar across districts in comparison with the Canadian Institute for Health Information (CIHI) method, where the values found were about one-quarter or less of those found in the other lists

Summary

Introduction

The determination of hospital admission rates for ACSCs has been increasingly used as an indicator to measure the quality and accessibility of primary health care [4,5,6]. The concept started to gain interest in the early 1990s in the United States (US) [1,7,8] and, over the years, many authors studied the impact of avoidable hospitalizations in different countries [9,10,11,12,13,14,15,16,17]. In some European countries, where access to primary health care (PHC) is universal, the concept of ACSCs is mostly applied to evaluate the quality of primary care, as it happens in Portugal, rather than to evaluate accessibility [10], which is. Public Health 2020, 17, 8121; doi:10.3390/ijerph17218121 www.mdpi.com/journal/ijerph

Objectives

Methods

Results

Discussion

Conclusion