Abstract
BackgroundHospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.MethodsUsing longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.ResultsWe found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.ConclusionsThe results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.
Highlights
Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care
Population achievement on the Quality and Outcomes Framework (QOF) indicators was generally high but ranged from 54.8 for the percentage of patients with Coronary Heart Disease (CHD) who are treated with a beta blocker therapy to 96.3 for the percentage of patients with CHD whose notes have a record of blood pressure in the previous 15 months
The results showed that only a small number of measures of the clinical quality of primary care is associated with reduced ACSC emergency admissions
Summary
Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. Conditions for which effective primary care management and treatment are expected to prevent hospital admissions are referred to as Ambulatory Care Sensitive Conditions (ACSC), which account for around 17% of all emergency admissions [1]. Key questions remain about the validity of these measures For these indicators to be robust and useful performance measures it is crucial that they are attributable and sensitive to changes in quality of primary care
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