Las hospitalizaciones por ambulatory care sensitive conditions: selección del listado de códigos de diagnóstico válidos para España

Abstract

BackgroundHospitalisations due to Ambulatory Care Sensitive Conditions (ACSC) are considered an indicator to measure the use of hospital services because of health conditions that could have been prevented and controlled by primary health care. The objective of this study is to select the list of diagnostic codes to assess the performance of primary health care in Spain. MethodsThe five criteria proposed by Weissman and Solberg, to select an appropriate indicator, were applied to a first list of 87 ACSC diagnostic codes identified through bibliographic search. Information on two main criteria –whether care for a health condition was a primary health care role and whether hospitalisation was needed once the health problem occurred– was obtained by means of the Delphi technique. A group of 44 experts gathered together for the study. For the remaining criteria, information came from the results of the «Pilot study on hospitalisations due to ACSC in Catalonia, Spain». Meeting the five criteria was the criterion selected to evaluate the solving ability of primary health care. Resultsa) from the Delphi group: 42 (95.4%) participants completed the three rounds. The question on whether the care of the selected health conditions was responsibility of primary health care reached a high level of consensus (between 86.1 and 100%). The consensus on the need for hospitalisation was lower, from 75.7 to 88.6%, moreover, 5 diagnostic codes did not reach the established consensus, and b) from the ACSC selection process: five diagnostic codes did not meet the criteria and were excluded. Out of the remaining 82, all them were considered as health problems to be cared for at primary level and in 37 cases hospitalisation was considered always as necessary. Thirty-five diagnostic codes, that met the five criteria, represented the set of ACSC diagnostic codes in our setting. ConclusionsA set of 35 diagnostic codes of ACSC, adapted to our setting, is proposed to evaluate primary health care performance. The selected codes reduce significantly the limitations that stem from hospital admission criteria due to patient clinical characteristics, variations in hospital medical practice, and hospital admission policies.