Ambulatory Care Sensitive Conditions Admission Rates Research Articles

Association between spatial access and hospitalization for ambulatory care sensitive conditions: A retrospective cohort study using claims data

BackgroundHospitalization for ambulatory care sensitive conditions (ACSCs) is potentially preventable with timely and effective primary care but may increase owing to poor access. Spatial access inequalities exist between Japan and other countries. This retrospective cohort study examined the association between admission for ACSC and spatial accessibility to primary care. MethodsWe used claims data and spatial data of 50–74 years-old beneficiaries of the National Health Insurance program in a large city in Japan from April 2013–March 2014 and followed them until March 2015. We used a multilevel Poisson regression model to assess the association between the number of ACSC admissions, the distance to the nearest clinic, and the number of physicians in a given area, adjusting for age, gender, comorbidities, number of visits, and household income. ResultsAmong 126,666 eligible beneficiaries (mean age 65.8 years, 54% were women), 1,793 (1.4%) were hospitalized for ACSCs. The ACSC admission rate was significantly higher in those with a distance to the nearest clinic of >1 km than in those with <0.3 km (incident rate ratio [IRR] 1.32, 95% confidence interval [CI] 1.03–1.69). In the stratified analyses, a longer distance to the nearest clinic was associated with higher ACSC admission rates among women (≥0.3 km and <0.5 km: IRR 1.48, 95% CI 1.01–2.17; ≥0.5 km and <1 km: IRR 1.74, 95% CI 1.19–2.56; >1 km: IRR 1.98, 95% CI 1.29–3.03, respectively) and those aged ≥65 years (≥0.3 km and <0.5 km: IRR 1.38, 95% CI 1.07–1.79; ≥0.5 km and <1 km: IRR 1.38, 95% CI 1.06–1.80; >1 km: IRR 1.48, 95% CI 1.10–1.98). ConclusionUnfavorable spatial access was associated with ACSC admissions, particularly among women and older adults.

National Norms for Hospitalizations Due to Ambulatory Care Sensitive Conditions among Adults in the US.

Ambulatory care sensitive conditions (ACSCs) are acute or chronic health issues that lead to potentially preventable hospitalizations when not treated in the outpatient primary care setting. To describe national hospitalization rates due to ACSCs among adult inpatients in the US. A retrospective cross-sectional analysis of the 2018 US National Inpatient Sample (NIS) dataset from the Healthcare Cost and Utilization Project at the Agency of Healthcare Research and Quality was completed in the year 2022. Participants were adult inpatients from community hospitals in 48 states of the US and District of Columbia. ACSC admission rates were calculated using ICD-10 codes and the Purdy ACSC definition. The admission rates were weighted to the US inpatient population and stratified by age, sex, and race. ACSC hospitalization rates varied considerably across age and average number of hospitalizations varied across sex and race. ACSC hospitalization rates increased with age, male sex, and Native American and Black race. The most common ACSCs were pneumonia, diabetes, and congestive heart failure. Previous studies have emphasized the importance of preventable hospitalizations, however, the national rates for ACSC hospitalizations across all ages in the US have not been reported. The national rates presented will facilitate comparisons to identify hospitals and health care systems with higher-than-expected rates of ACSC admissions that may suggest a need for improved primary care services.

Identifying patterns of potentially preventable hospitalisations in people living with dementia

BackgroundOlder Australians make up 46% of all potentially preventable hospitalisations (PPHs) and people living with dementia are at significantly greater risk. While policy reforms aim to reduce PPHs, there is currently little evidence available on what drives this, especially for people living with dementia. This study examines patterns of PPHs in people living with dementia to inform service delivery and the development of evidence-based interventions.MethodsWe used the Victorian Admitted Episodes Dataset from Victoria, Australia, to extract data for people aged 50 and over with a diagnosis of dementia between 2015 and 2016. Potentially avoidable admissions, known as ambulatory care sensitive conditions (ACSCs), were identified. The chi-square test was used to detect differences between admissions for ACSCs and non-ACSCs by demographic, geographical, and administrative factors. Predictors of ACSCs admissions were analysed using univariate and multiple logistic regression.ResultsOf the 8156 hospital records, there were 3884 (48%) ACSCs admissions, of which admissions for urinary tract infections accounted for 31%, followed by diabetes complications (21%). Mean bed-days were 8.26 for non-ACSCs compared with 9.74 for ACSCs (p ≤ 0.001). There were no differences between admissions for ACSCs and non-ACSCs by sex, marital status, region (rural vs metro), and admission source (private accommodation vs residential facility). Culture and language predicted ASCS admission rates in the univariate regression analyses, with ACSC admission rates increasing by 20 and 29% if English was not the preferred language or if an interpreter was required, respectively. Results from the multiple regression analysis confirmed that language was a significant predictor of ACSC admission rates.ConclusionsImproved primary health care may help to reduce the most common causes of PPHs for people living with dementia, particularly for those from culturally and linguistically diverse backgrounds.

The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis

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.

Do hospitalisations for ambulatory care sensitive conditions reflect low access to primary care? An observational cohort study of primary care usage prior to hospitalisation

ObjectivesTo explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care.DesignObservational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink...

Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation

Reducing unplanned hospital admissions is a key priority within the UK. Substantial interpractice variation in admission rates for ambulatory care sensitive conditions (ACSC) suggests that decreases might be possible. To identify the clinical areas and patient subgroups where the greatest opportunities exist for GPs to improve ACSC care. Cross-sectional study using routine hospital data from patients registered at 8123 English GP practices during 2011 and 2012. The authors used random effects Poisson models to estimate interpractice variation after adjusting for several drivers of healthcare need and availability of local hospital services. Interpractice variation was contrasted across patient subgroups based on age. There were 1.8 million hospital admissions. Overall, high-utilisation practices had ACSC admission rates that were 55% (95% CI = 53 to 56) greater than low-utilisation practices. Differences of 67% (95% CI = 65 to 69) were found for chronic ACSCs, which was much larger than the 51% (95% CI = 49 to 52) difference exhibited by acute presentations. At least two-fold differences were found for 15 (54%) ACSCs, although large interpractice variations were not ubiquitous. Admission rates were consistently more variable among younger-than-average patients. The most variable conditions tended to disproportionately affect deprived patients. Substantial interpractice variation suggests that current efforts to standardise primary care have had a limited effect on unplanned hospital admissions. GPs and healthcare commissioners should ensure they are offering best practice care for the most variable clinical areas and patient subgroups identified in the study, particularly in adults aged <70 years with chronic conditions.

A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions

BackgroundUnplanned hospital admissions place a large and increasing strain on healthcare budgets worldwide. Many admissions for ambulatory care sensitive conditions (ACSCs) are thought to be preventable, a belief supported by significant geographic variations in admission rates. We conducted a systematic review of the evidence on the magnitude and correlates of geographic variation in ACSC admission rates and length of stay (LOS).MethodsWe performed a search of Medline and Embase databases for English language cross-sectional and cohort studies on 28th March 2013 reporting geographic variation in admission rates or LOS for patients receiving unplanned care across at least 10 geographical units for one of 35 previously defined ACSCs. Forward and backward citation searches were undertaken on all included studies. We provide a narrative synthesis of study findings. Study quality was assessed using a modified Newcastle-Ottawa scale.ResultsWe included 39 studies comprising 25 on admission rates and 14 on LOS. Studies generally compared admission rates between regions (e.g. states) and LOS between hospitals. Most of the published research was undertaken in the US, UK or Canada and often focussed on patients with pneumonia, COPD or heart failure. 35 (90 %) studies concluded that geographic variation was present. Primary care quality and secondary care access were frequently suggested as drivers of admission rate variation whilst secondary care quality and adherence to clinical guidelines were often listed as contributors to LOS variation. Several different methods were used to quantify variation, some studies listed raw data, failed to control for confounders and used naive statistical methods which limited their utility.ConclusionsThe substantial geographical variations in the admission rates and LOS of potentially avoidable conditions could be a symptom of variable quality of care and should be a concern for clinicians and policymakers. Policymakers targeting a reduction in unplanned admissions could introduce initiatives to improve primary care access and quality or develop alternatives to admission. Those attempting to curb unnecessarily long LOS could introduce care pathways or guidelines. Methodological work on the quantification and reporting of geographic variation is needed to aid inter-study comparisons.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0964-3) contains supplementary material, which is available to authorized users.

Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison.

Admissions for ambulatory care sensitive conditions (ACSCs) are considered preventable and indicators of poor access to primary care. We wondered whether per-capita rates of admission for ACSCs in France demonstrated geographic variation, were changing, were related to other independent variables, or were comparable to those in other countries; further, we wanted to quantify the resources such admissions consume. We calculated per-capita rates of admission for five categories (chronic, acute, vaccination preventable, alcohol-related, and other) of ACSCs in 94 departments in mainland France in 2009 and 2010, examined measures and causes of geographic variation in those rates, computed the costs of those admissions, and compared rates of admission for ACSCs in France to those in several other countries. The highest ACSC admission rates generally occurred in the young and the old, but rates varied across French regions. Over the 2-year period, rates of most categories of ACSCs increased; higher ACSC admission rates were associated with lower incomes and a higher supply of hospital beds. We found that the local supply of general practitioners was inversely associated with rates of chronic and total ACSC admission rates, but that this relationship disappeared if we accounted for patients' use of general practitioners in neighboring departments. ACSC admissions cost 4.755 billion euros in 2009 and 5.066 billion euros in 2010; they consumed 7.86 and 8.74 million bed days of care, respectively. France had higher rates of ACSC admissions than most other countries examined. Because admissions for ACSCs are generally considered a failure of outpatient care, cost French taxpayers substantial monetary and hospital resources, and appear to occur more frequently in France than in other countries, policymakers should prioritize targeted efforts to reduce them.

Ambulatory Care Sensitive Conditions in Portugal: Is there room for improvement?

Introduction: The healthcare systems worldwide face a challenge posed by the increasing life expectancy, the growing prevalence of non-communicable diseases and the resulting increased demand for resources(1). The integration of care, with the purpose of increasing quality and access (among others) has been widely discussed as a possible solution in this context(1). The Ambulatory Care Sensitive Conditions (ACSC) have proven to be a valid indicator of both Primary Care access and quality(2). In Portugal there is no framework on ACSC or any knowledge of the magnitude of these admissions(3). Objectives • Determine and characterize the ACSC admissions in Portugal. • Characterize the historic evolution of the rate of admissions for ACSC. • Evaluate the impact of the utilization of different lists of ACSC. Methods: The authors undertook an observational, descriptive and analytic study which analyzed data from 4.754.560 hospital admissions of mainland Portuguese residents. The data was sourced from the national admissions databases, from 2007 through 2011. The ACSC admissions were identified according to the Canadian Institute for Health Information(CIHI)(4) and the Spanish list(5). The rates for admission were calculated using the National Statistics Institute’s population estimates for the given year, detailed by municipality. Results: The national rate of admissions for ACSC, according to the CIHI list, has steadily decreased since 2007, from 244,2 to 218,5 (adm/100.000). This was not similar using the Spanish list neither in number nor tendency. It varied from 1539,6 in 2007 increasing to 1608,3 in 2009 and decreasing in 2011 to 1577,5 (adm/100.000). In 2011 the admissions for ACSC accounted for 4,4% and 31,8% of the admissions for medical causes according to the CIHI and Spanish lists respectively. In the CIHI list the most frequent conditions were heart failure (23,3%) and COPD (21,5%), while according to the Spanish list they were Pneumonia (24,2%) and hypertensive heart disease (21,2%). 14th International Conference on Integrated Care, Brussels, April 2-4 2014 International Journal of Integrated Care – Volume 14, 01 October – URN:NBN:NL:UI:10-1-116212 – http://www.ijic.org/ Among the municipalities, according to, the CIHI list, the admission rates for ACSC varied from 51,2 to 732,5 (adm/100.000) (mean 225,5 SD 92,9) and from 720,0 to 3705,6 (adm/100.000) (mean 1733,5 SD 488,1) in the Spanish list. After splitting the municipalities by quintiles it was possible to establish improvement scenarios (up the ladder/all the best)(6), which resulted in estimated reductions in ACSC admission rates between 20% and 45% for the CIHI list and between 13% and 27% for the Spanish list. Discussion/Conclusion. The lists are fundamentally different, while the Spanish includes conditions sensitive to primary prevention, early diagnosis/treatment as well as chronic conditions, the CIHI list includes only chronic conditions. This explains the difference in the number of cases. Therefore the scope of the assessment is much broader in the Spanish list. The inclusion and exclusion criteria are also different, for example, in the Spanish list, the admissions for cardiovascular conditions with cardiac procedures are not excluded. For these reasons a further discussion on the scope of the evaluation of the ACSC, as well as the specificity of the code list, needs to take place in Portugal. There are important regional differences that should be addressed from a policy standpoint, once there are regional clusters of under-average performance. The potential for improvement therefore exists.

The Small Area Predictors of Ambulatory Care Sensitive Hospitalizations: A Comparison of Changes over Time

The hospital admission for ambulatory care sensitive conditions (ACSCs) is a validated indicator of impeded access to good primary and preventive care services. The authors examine the predictors of ACSC admissions in small geographic areas in two cross-sections spanning an 11-year time interval (1995–2005). Using hospital discharge data from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for Arizona, California, Massachusetts, Maryland, New Jersey, and New York for the years 1995 and 2005, the study includes a multivariate cross-sectional design, using compositional factors describing the hospitalized populations and the contextual factors, all aggregated at the primary care service area level. The study uses ordinary least squares regressions with and without state fixed effects, adjusting for heteroscedasticity. Data is pooled over 2 years to assess the statistically significant changes in associations over time. ACSC admission rates were inversely related to the availability of local primary care physicians, and managed care was associated with declines in ACSC admissions for the elderly. Minorities, aged elderly, and percent under federal poverty level were found to be associated with higher ACSC rates. The comparative analysis for 2 years highlights significant declines in the association with ACSC rates of several factors including percent minorities and rurality. The two policy-driven factors, primary care physician capacity and Medicare-managed care penetration, were not found significantly more effective over time. Using small area analysis, the study indicates that improvements in socioeconomic conditions and geographic access may have helped improve the quality of primary care received by the elderly over the last decade, particularly among some minority groups.

Small Area Analysis of Ambulatory Care Sensitive Conditions in Victoria, Australia

Ambulatory care sensitive conditions (ACSCs) are used as a measure of access to primary health care. The purpose of this study was to identify factors associated with variation in ACSC admissions at a small area level in Victoria, Australia. The study was ecologic, using Victorian Primary Care Partnerships (PCPs) as the unit of analysis. Data sources were the Victorian Admitted Episodes Dataset, census data from the Australian Bureau of Statistics, and the Victorian Population Health Survey. Age- and sex-adjusted total ACSC admission rates were calculated, and weighted least squares multiple linear regression was used to examine the associations of total ACSC admission rates by various predictor variables. Key variables were categorized into 1 of 4 framework components for analyzing access and use of health care services: predisposing, enabling, need, or structural. Enabling characteristics explained 61.70% of the variation in ACSC admission rates across PCPs. Socioeconomic characteristics (income, education) and percentage with poor self-rated health were important factors in explaining variations in ACSC admissions at a small area-level [R(2)=0.77]. Community-level variables differentially affect access to primary health care, with significant variation by socioeconomic status. This analytical approach will assist researchers to identify community-level predicators of access across populations at locations, including factors that may be affected by policy change.

The Concept and Usefulness of Ambulatory Care Sensitive Conditions as Indicators of Quality and Access to Primary Health Care

The purpose of this review is to introduce health services researchers, especially in the area of primary health care, to the meaning and concept of ambulatory care sensitive conditions (ACSCs). More specifically, this review explores the validity of ACSC admissions as proxy indicators of access to primary health care, provides a description of the factors that cause variations in ACSC admission rates, and presents a discussion of the potential usefulness and policy implications of these indicators for primary health care. Critical Interpretive Synthesis (CIS) methodology was used to review the literature on ACSC admissions indicators. Medline and Australasian Medical Index were searched for English language articles published between 1970 and August 2005. The results were supplemented by an internet search of the World Wide Web, further augmented by manual scans of material from deeper levels within the sites. Main finding from the review indicates that ACSC admissions are valid proxy indicators of access to primary health care. Socioeconomic factors are most important in explaining variations in ACSC admissions. Several uses and policy implications of ACSC admission indicators are discussed, including their potential for identifying gaps in the primary health care system and providing opportunities for targeted public health and health services interventions.

Spatial analysis of elderly access to primary care services

BackgroundAdmissions for Ambulatory Care Sensitive Conditions (ACSCs) are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance) are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates.ResultsWe examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas.ConclusionThe relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across the landscape may not be optimal. The finding that elderly who reside in sprawling urban areas have access impediments about equal to residents of poor rural communities is new, and demonstrates the value of conceptualizing and modelling impedance based on place and local context.

La Atención Primaria de Salud y las hospitalizaciones por Ambulatory Care Sensitive Conditions en Cataluña

Ambulatory Care Sensitive Conditions (ACSC) are a set of selected codes of hospital discharge diagnosis intended to measure avoidable hospitalizations. Primary Health Care Services may avoid the hospitalizations due to ACSC by applying any of the following interventions, that are characteristics of this level of care: a) primary prevention; b) secondary prevention, and c) tertiary prevention and rehabilitation. Observational, cross-sectional pilot study on 248,174 hospital discharges, from a population of 2,248,704 inhabitants in 161 Basic Health Care Units (BHCU), recorded in the minimum basic set of hospital discharge data in Catalonia during 1996. The complete list of diagnostic codes of ACSC, identified in the literature search, has been used. Crude and age-standardised hospitalisation rates have been estimated. Standardised hospitalisation ratio (SHR) has been computed to compare hospitalisation rates between BHCU. To analyse the effect of variables associated with high ACSC admission rates, multivariate analysis has been carried out by means of Poisson's regression. Hospitalisation due to ACSC account for 13% of all hospitalizations and 16% of hospital stay days. Acute and chronic diseases of the lower respiratory tract are the first cause of hospitalisation at any age group (< 5, 15-64 and > or = 65 years). The most common diagnostic groups, for all ages are respiratory disorders (acute and chronic diseases of the lower respiratory tract and pneumonia) and urinary tract conditions (pyelonephritis/urinary tract infection). The so-called self-limited health problems (ear, nose and throat mild infections/infections of the upper respiratory tract, febrile convulsions in children and gastroenteritis) account for more than 10% of all hospitalizations by ACSC, 45% of which occur in children. The overall crude hospitalisation rate by ACSC is 146.9/10,000 inhabitants (range: 12.4/10,000-239.9/10,000). SHR ranges from 0.01 to 1.85. "Hospital admissions due to ACSC" is a valid indicator to assess global performance of Primary Health Care and it identifies a part of hospital activity that is amenable to be cared for at Primary Health Care level and therefore potentially avoidable.