Ambulatory Care Sensitive Conditions Research Articles

A composite index of avoidable hospitalization to assess primary care quality: an Italian experience

Abstract Background In Italy, primary care (PC) ensures universal health coverage while containing costs. However, the assessment of its quality still remains an issue. Evidence has shown that high-quality outpatient care, through timely interventions to prevent complications of “ambulatory care sensitive conditions”, may avoid hospitalization. Aim of the study is to analyse the performance of PC in the Italian regions, using a composite and synthetic index of avoidable hospitalizations. Methods Hospital discharge data from 119 Italian geopolitical areas were analysed for the 2017-2019 triennium and for 2020, separately. According to the “Italian National Outcomes Evaluation Programme” methodology, 9 avoidable hospitalization indicators covering 5 nosological fields (infectious, respiratory, metabolic, cardiovascular and mental diseases) were combined in a synthetic index, calculated as the weighted mean of their standardized scores (with equal weights for each field). Using “natural breaks” technique, the areas were grouped into 5 clusters: “high”, “medium-high”, “medium”, “medium-low” and “low”. Results The analysis showed a marked heterogeneity at intra-regional level for the pre-pandemic triennium, with areas of homogeneity in regions with higher levels of hospitalization. The “medium” cluster, which is the widest, included 36 areas variously distributed across regions. The comparison with 2020 confirmed the geographical patterns observed for the previous triennium, despite a general reduction in hospitalizations due to the pandemic. Conclusions As a proxy indicator of PC quality, this index can aid decision makers in prioritizing quality improvement actions. However, in order to obtain a comprehensive evaluation, a joint reading of this index with other healthcare indicators is recommended. Key messages • High-quality PC is essential in maintaining appropriate hospitalization levels. • The composite synthetic index proposed could aid PC quality assessment.

Meso-level ambulatory care and ambulatory care sensitive hospitalizations in Germany

Abstract Ambulatory care sensitive hospitalizations are widely considered as important measures of access to as well as quality and performance of primary care. In our study, we investigate the impact of spending, process quality and continuity of care in the ambulatory care sector on ambulatory care sensitive hospitalizations in patients with type 2 diabetes. We used observational data from Germany's major association of insurance companies from 2012 to 2014 with 55,924 patients, as well as data from additional regional data sources. We conducted negative binomial regression analyses with random effects at the district level. To control for potential endogeneity of spending and physician density in the ambulatory care sector, we used an instrumental variable approach. In doing so, we adjust for a number of known risk factors for hospitalizations among this patient group. We undertook a Shorrocks-Shapley decomposition to investigate the relative contribution of groups of regressors to the pseudo R2. The results of our analysis suggest that spending in the ambulatory care sector has weak negative effects on ambulatory care sensitive hospitalizations. We also found that continuity of care was negatively associated with hospital admissions. Patients with type 2 diabetes are at increased risk of hospitalization resulting from ambulatory care sensitive conditions. The results of the decomposition analysis for groups of variables indicate that ambulatory care characteristics account for 9.8% of the pseudo R2, morbidity of patients (including gender and age groups) for about 85.5%, and system-related factors of health provision for 4.7%. Our study provides some evidence that meso-level factors such as increased spending and improved continuity of care while controlling for process quality in the ambulatory care sector may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with type 2 diabetes.

Inequalities in hospitalizations for ambulatory care sensitive conditions in New York City before and after the affordable care act

AbstractThe Patient Protection and Affordable Care Act (ACA) was signed into law by U.S. President Obama in 2010 and fully implemented in 2014. The ACA expanded health insurance by expanding the Medicaid program, creating health insurance exchanges (now called “marketplaces”) in which people with incomes between 139% and 400% of the federal poverty level, could purchase subsidized insurance coverage, and by regulating health insurance to eliminate practices such as denying coverage to people with pre‐existing conditions, or basing premiums on health status. We investigate the effects of the ACA's implementation on access to ambulatory health services in New York City by comparing rates of hospitalizations for ambulatory care‐sensitive conditions (ACSC) before and after the full implementation of the law. Although the ACA was associated with a significant decrease in the rate of ACSC in NYC, we find that there continue to be systemic inequalities by gender, race, ethnicity, income, and insurance status. We argue that the broader social and economic inequalities at the national and state levels, including tax and spending policies that have led to increased income and wealth inequalities, help explain why we see persistent inequalities in hospitalizations for ACSC.

Impact of COVID-19 infection rates on admissions for ambulatory care sensitive conditions: nationwide difference-in-difference design in Japan

ObjectivesSARS-CoV-2 infection (COVID-19) has affected tertiary medical institutions and primary care. Admission for ambulatory care sensitive conditions (ACSCs) is an important indicator of primary care quality. However, no nationwide study,...

Does the definition of preventable emergency department visit matter? An empirical analysis using 20 million visits in Ontario and Alberta.

This study had two objectives: (1) to estimate the prevalence of preventable emergency department (ED) visits during the 2016-2020 time period among those living in 19 large urban centers in Alberta and Ontario, Canada, and (2) to assess if the definition of preventable ED visits matters in estimating the prevalence. A retrospective, population-based study of ED visits that were reported to the National Ambulatory Care Reporting System from April 1, 2016, to March 31, 2020, was conducted. Preventable ED visits were operationalized based on the following approaches: (1) Canadian Triage and Acuity Scale (CTAS), (2) ambulatory care-sensitive conditions (ACSC), (3) family practice-sensitive conditions (FPSC), and (4) sentinel nonurgent conditions (SNC). The overall proportion of ED visits that were preventable was estimated. We also estimated the adjusted relative risks of preventable ED visits by patients' sex and age, fiscal year, province of residence, and census metropolitan area (CMA) of residence. There were 20,171,319 ED visits made by 8,919,618 patients ages 1 to 74 who resided in one of the 19 CMAs in Alberta or Ontario. On average, there were 2.26 visits per patient over the period of 4 fiscal years; most patients made one (44.22%) or two ED visits (20.72%). The overall unadjusted prevalence of preventable ED visits varied by definition; 35.33% of ED visits were defined as preventable based on CTAS, 12.88% based on FPSC, 3.41% based on SNC, and 2.33% based on ACSC. There is a substantial level of variation in prevalence estimates across definitions of preventable ED visits, and care should be taken when interpreting these estimates as each has a different meaning and may lead to different conclusions. The conceptualization and measurement of preventable ED visits is complex and multifaceted and may not be adequately captured by a single definition.

Outpatient Care Fragmentation and Acute Care Utilization in Veterans Affairs Home-Based Primary Care

Veterans Affairs (VA) Home-Based Primary Care (HBPC) provides comprehensive, interdisciplinary primary care at home to patients with complex, chronic, disabling disease, but little is known about care fragmentation patterns and consequences among these patients. To examine outpatient care fragmentation patterns and subsequent acute care among HBPC-engaged patients at high risk of hospitalization or death. This retrospective cohort study included VA patients aged at least 65 years who were enrolled in the VA and Medicare, whose risk of hospitalization or death was in the top 10%, and who had at least 4 outpatient visits between October 1, 2013, and September 30, 2014. HBPC engagement was defined as having at least 2 HBPC encounters between July 1, 2014, and September 30, 2014. Data were analyzed from March 2020 to March 2022. Two indices of outpatient care fragmentation: practitioner count and the Usual Provider Continuity Index (UPC), based on VA and non-VA health care use from October 1, 2013, to September 30, 2014. All care delivered by HBPC clinicians was analyzed as coming from a single practitioner. Emergency department (ED) visits and hospitalizations for ambulatory care sensitive conditions (ACSC) from VA records and Medicare claims from October 1, 2014, to September 30, 2015. Among 8908 identified HBPC patients, 8606 (96.6%) were male, 1562 (17.5%) were Black, 249 (2.8%) were Hispanic, 6499 (73.0%) were White, 157 (1.8%) were other race or ethnicity, and 441 (5.0%) had unknown race or ethnicity; the mean (SD) age was 80.0 (9.02) years; patients had a mean (SD) of 11.25 (3.87) chronic conditions, and commonly had disabling conditions such as dementia (38.8% [n = 3457]). In adjusted models, a greater number of practitioners was associated with increased odds of an ED visit (adjusted odds ratio [aOR], 1.05 [95% CI, 1.03-1.07]) and hospitalization for an ACSC (aOR, 1.04 [95% CI, 1.02-1.06]), whereas more concentrated care with a higher UPC was associated with reduced odds of these outcomes (highest vs lowest tertile of UPC: aOR for ED visit, 0.77 [95% CI, 0.67-0.88], aOR for ACSC hospitalization, 0.78 [95% CI, 0.68-0.88]). Among patients in HBPC, fragmented care was associated with more ED visits and ACSC hospitalizations. These findings suggest that consolidating or coordinating fragmented care may be a target for reducing preventable acute care.

The impact of not having a primary care provider on emergency department utilization and hospitalizations before and during COVID-19: A novel retrospective cohort study linking primary care waitlists with administrative billing data.

ObjectivesPrimary care attachment improves access, chronic disease prevention and management. Growing proportions of Canadians are unattached and registering with provincial primary care waitlists for family doctors or nurse practitioners. We compare emergency department utilization and hospitalization by waitlist registration status both before and during the first two waves of COVID-19. ApproachThis study is the first to link a provincial primary care waitlist with routinely collected administrative billing data. Access and linking required collaboration and processes to establish permissions and rigour. A descriptive cohort design estimates quarterly population-based rates of emergency department utilization and ambulatory care sensitive condition (ACSC) hospitalizations among persons on and off the waitlist between Jan/01/2017-Dec/24/2020. Emergency department utilization and ACSC hospitalization rates by current waitlist status were quantified from physician claims and hospitalization data. Relative differences during COVID-19 first (Q2 2020; April-June 2020) and second waves (Q4 2020; October-December 2020) were compared with the previous year. ResultsCentralized waitlist and administrative billing data were successfully linked. During the study period, 100,867 primary care-eligible Nova Scotians (10.1% of the population) were on the waitlist. Those on the waitlist had higher emergency department utilization each quarter, and more ACSC hospitalizations for most quarters, than those not on the waitlist. Emergency department utilization was higher for individuals ≥65 years and females; lowest during the first two COVID-19 waves; and differed more by waitlist status for those <65 years. Emergency department contacts and ACSC hospitalizations decreased during COVID-19 relative to the previous year. Emergency department utilization during COVID-19 was lower compared to analogous previous year quarters and this relative difference was more pronounced for those on the waitlist during the second wave of COVID-19. ConclusionLinking novel data sources identified that Nova Scotians seeking primary care attachment utilize hospital-based services more frequently than those not on the waitlist. Both groups had lower utilization during the COVID-19 pandemic than the year before. The degree to which forgone services produces downstream health burden remains to be seen.

Developing Machine Learning Algorithms on Routinely Collected Administrative Health Data - Lessons from Ontario, Canada.

There has been considerable growth in the development of machine learning models for clinical applications; however, less attention has been paid to applications at the health systems level. Here, we survey recent models developed using provincial administrative health data holdings in Ontario, Canada to synthesize key learnings across use cases. We have developed four models in the areas of diabetes incidence and complications, hospitalization due to ambulatory care sensitive conditions, and hospitalization due to SARS-CoV-2 infection. Our team was highly multidisciplinary with expertise across clinical medicine, administrative health data, epidemiology, and computer science. We used a “sliding window” approach to aggregate healthcare events across multiple health administrative data sets chronologically and map them dynamically onto a patient timeline. Tree-based algorithms, specifically gradient boosted decision trees, are well suited for the underlying tabular structure of administrative data and were used for each prediction task. Our models achieved excellent discrimination, measured by the area under the receiver operating characteristic curve, between 0.77-0.85 at prediction windows between 30 days and 3 years in advance. They were also well-calibrated, both in-the-large and in population subgroups such as older adults, those living in rural areas, and the materially deprived. Measures of feature importance revealed that our models were leveraging predictors across administrative datasets (e.g. demographics, interactions with the healthcare system, medications) in intuitive and defensible ways. Finally, we demonstrated the utility of our models with “recall at top k” metrics - for example, the top 1% of patients predicted at risk of diabetes complications represented a cost of over $400 million to the healthcare system. We identify three key learnings needed for the successful application of machine learning methods to health administrative data: synergy between nature of training data and intended algorithm use, adherence to methodological best practices for rigour and transparency, and multidisciplinary teams with expertise across data provenance, methodological approach, and impact assessment.

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity.

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity.

Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review

BackgroundEmergency department (ED) visits for nursing home residents lead to higher morbidity and mortality. Therefore, inappropriate visits (for conditions treatable elsewhere) or potentially avoidable visits (those avoidable through adequate chronic care management) must be minimized. This study aimed to investigate factors and resource consumption patterns associated with inappropriate and potentially avoidable visits in a Swiss tertiary hospital.MethodsThis is a single-center retrospective chart review in an urban Swiss university hospital ED. A consecutive sample of 1276 visits by nursing home residents (≥ 65 years old), recorded between January 1, 2015 and December 31, 2017 (three calendar years) were included. Case characteristics were extracted from ED electronic documentation. Appropriateness was assessed via a structured Appropriateness Evaluation Protocol; potentially avoidable visits—measured as ambulatory-care sensitive conditions (ACSCs)—were analyzed separately. Inter-group differences concerning ED resource use were tested respectively with chi-square or Wilcoxon rank sum tests. To identify predictors of inappropriate or potentially-avoidable visits, we used multivariable logistic regression analysis.ResultsSix percent of visits were rated as inappropriate: they had lower triage levels (OR 0.55 [95%-CI 0.33-0.92], p=0.024) and, compared to ambulance calls, they had higher odds of initiation via either patient-initiated walk-in (OR 3.42 [95%-CI 1.79-6.55], p≤0.001) or GP referrals (OR 2.13 [95%-CI 1.16-3.90], p=0.015). For inappropriate visits, overall ED resource use was significantly lower (median 568 vs. 1403 tax points, p≤0.001). Of all visits included, 29% were due to (often potentially-avoidable) ACSCs. In those cases, compared to ambulance initiation, odds of being potentially-avoidable were considerably lower for walk-in patients (OR 0.46 [95%-CI 0.27-0.77], p=0.004) but higher for GP referrals (OR 1.40 [95%-CI 1.00-1.94], p=0.048). Nurse work (93 tax points vs. 64, p≤0.001) and laboratory resource use (334 tax points vs. 214, p≤0.001) were higher for potentially-avoidable ED visits.ConclusionsWe revealed substantial differences between the investigated groups. While nearly one third of ED visits from nursing homes were potentially avoidable, inappropriate visits were lower in numbers and not resource-intensive. Further research is required to differentiate potentially avoidable visits from inappropriate ones and to determine these findings’ public health implications.

Trends in all-cause mortality and inpatient and outpatient visits for ambulatory care sensitive conditions during the first year of the COVID-19 pandemic: A population-based study.

BackgroundThe impact of the COVID‐19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown.ObjectivesTo compare observed and expected (projected based on previous years) trends in all‐cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 to March 2021).Design, Setting and ParticipantsWe conducted a population‐based study using provincial health administrative data on general adul population (Ontario, Canada).Outcomes and MeasuresMonthly all‐cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at‐risk) for seven combined ACSCs (asthma, chronic obstructive pulmonary disease, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016–2019) by fitting monthly time series autoregressive integrated moving‐average models.ResultsCompared to previous years, all‐cause mortality rates increased at the beginning of the pandemic (observed rate in March to May 2020 of 79.98 vs. projected of 71.24 [66.35–76.50]) and then returned to expected in June 2020—except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 versus projected of 52.07 (47.84–56.68); observed ED visit rate of 92.55 versus projected of 134.72 (124.89–145.33). ACSC outpatient visit rates decreased initially (observed rate of 4299.57 vs. projected of 5060.23 [4712.64–5433.46]) and then returned to expected in June 2020.

Factors associated with mortality of the elderly due to ambulatory care sensitive conditions, between 2008 and 2018, in the Federal District, Brazil.

In Brazil, the Unified Health System (Sistema Único de Saúde, or SUS) provides health care, and an aging population overwhelms the system due to the greater vulnerability of the elderly. In the Federal District, two models of primary care coexist-the traditional primary care and the family health strategy. The present study aimed to analyze the factors associated with mortality of the elderly due to conditions sensitive to ambulatory care in the Federal District, Brazil. This cross-sectional study investigated all deaths that occurred in people over 60 years old between 2008 and 2018. The variables studied were age at death, sex, marital status, education, race/color, death by condition sensitive to ambulatory care, and population coverage of primary care services. The Urban Well-Being Index (UWBI) was used, which includes the dimensions: mobility, environmental and housing conditions, infrastructure, and collective services, to analyze issues related to the place where the senior citizen resides. The deaths 70,503 senior citizens were recorded during the study period. The factors associated with mortality in the elderly due to ambulatory care sensitive conditions were male, lower income, and less education. Residing in a place with poor UWBI presented a response gradient with higher mortality. Increased ambulatory care coverage was also associated with lower mortality. The study evidenced an association between male gender, age, income, and education, and UWBI with lower mortality due to ambulatory care sensitive conditions, and these associations presented a response gradient. The study also found that increased coverage of the elderly population was associated with lower mortality from sensitive conditions.

Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters: A Systematic Review.

Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well-established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes. We conducted a systematic review to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers. A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered. The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.

The association between primary care use and potentially-preventable hospitalization among dual eligibles age 65 and over

BackgroundIndividuals dually-enrolled in Medicare and Medicaid (dual eligibles) are disproportionately sicker, have higher health care costs, and are hospitalized more often for ambulatory care sensitive conditions (ACSCs) than other Medicare beneficiaries. Primary care may reduce ACSC hospitalizations, but this has not been well studied among dual eligibles. We examined the relationship between primary care and ACSC hospitalization among dual eligibles age 65 and older.MethodsIn this observational study, we used 100% Medicare claims data for dual eligibles ages 65 and over from 2012 to 2018 to estimate the likelihood of ACSC hospitalization as a function of primary care visits and other factors. We used linear probability models stratified by rurality, with subgroup analyses for dual eligibles with diabetes or congestive heart failure.ResultsEach additional primary care visit was associated with an 0.05 and 0.09 percentage point decrease in the probability of ACSC hospitalization among urban (95% CI: − 0.059, − 0.044) and rural (95% CI: − 0.10, − 0.08) dual eligibles, respectively. Among dual eligibles with CHF, the relationship was even stronger with decreases of 0.09 percentage points (95% CI: − 0.10, − 0.08) and 0.15 percentage points (95% CI: − 0.17, − 0.13) among urban and rural residents, respectively.ConclusionsIncreased primary care use is associated with lower rates of preventable hospitalizations for dual eligibles age 65 and older, especially for dual eligibles with diabetes and congestive heart failure. In turn, efforts to reduce preventable hospitalizations for this dual-eligible population should consider how to increase access to and use of primary care.

Trends in avoidable hospitalization rates in Italy, 2001-2008


 Background: hospitalization for Ambulatory Care Sensitive Conditions (AC SC), also known as avoidable hospitalization (AH) has been proposed as effect measure of the accessibility and effectiveness of primary care. In the last years in developed countries, including Italy, hospitalization rates have decreased as well as the rates of AH. The decline of AH-rates could be just an effect of the general trend of hospitalization. The objective of our study was to examine the adjusted trend of AH rates and to test possible associations with measures of primary care (re)organization.
 Methods: hospital discharges from 2001 to 2008 were analyzed. Main outcome measures were hospitalization rates, both as inpatient and day hospital. ACSCs were grouped in acute conditions, preventable through early diagnoses and treatment and chronic conditions, preventable through good ongoing control and management. Expected time-series rates of AH, estimated on the hypothesis of same time trends of Total Hospitalization (TH), were compared with observed ones using a Chi Square test. Adjusted hospitalization rates were analyzed in conjunction with indicators of primary care.
 Results: in the studied period, in Italy, the TH rates declined with an average decrease of 19.6%, while the decrease for AH was 16.4%. The rates of AH adjusted for the trend of TH significantly decreased only for chronic conditions. Decreasing trend of AH was correlated with the impact of reorganization of primary care in associative forms.
 Conclusions: the presented methodology can be used to evaluate the real effectiveness of policies aimed at reducing hospitalization for ACSCs.

Emergency departments in the United States treating high proportions of patients with ambulatory care sensitive conditions: a retrospective cross-sectional analysis

BackgroundOne in nine emergency department (ED) visits by Medicare beneficiaries are for ambulatory care sensitive conditions (ACSCs). This study aimed to examine the association between ACSC ED visits to hospitals with the highest proportion of ACSC visits (“high ACSC hospitals) and safety-net status.MethodsThis was a cross-sectional study of ED visits by Medicare fee-for-service beneficiaries ≥ 65 years using 2013–14 claims data, Area Health Resources File data, and County Health Rankings. Logistic regression estimated the association between an ACSC ED visit to high ACSC hospitals, accounting for individual, hospital, and community factors, including whether the visit was to a safety-net hospital. Safety net status was measured by Disproportionate Share Hospital (DSH) index patient percentage; public hospital status; and proportion of dual-eligible beneficiaries. Hospital-level correlation was calculated between ACSC visits, DSH index, and dual-eligible patients. We stratified by type of ACSC visit: acute or chronic.ResultsAmong 5,192,729 ACSC ED visits, the odds of visiting a high ACSC hospital were higher for patients who were Black (1.37), dual-eligible (1.18), and with the highest comorbidity burden (1.26, p < 0.001 for all). ACSC visits had increased odds of being to high ACSC hospitals if the hospitals were high DSH (1.43), served the highest proportion of dual-eligible beneficiaries (2.23), and were for-profit (relative to non-profit) (1.38), and lower odds were associated with public hospitals (0.64) (p < 0.001 for all). This relationship was similar for visits to high chronic ACSC hospitals (high DSH: 1.59, high dual-eligibility: 2.60, for-profit: 1.41, public: 0.63, all p < 0.001) and to a lesser extent, high acute ACSC hospitals (high DSH: 1.02; high dual-eligibility: 1.48, for-profit: 1.17, public: 0.94, p < 0.001). The proportion of ACSC visits at all hospitals was weakly correlated with DSH proportion (0.2) and the proportion of dual-eligible patients (0.29), and this relationship was also seen for both chronic and acute ACSC visits, though stronger for the chronic ACSC visits.ConclusionVisits to hospitals with a high proportion of acute ACSC ED visits may be less likely to be to hospitals classified as safety net hospitals than those with a high proportion of chronic ACSC visits.

The Characteristics and Outcomes of Patients Transported by Ambulance Due to Ambulatory Care Sensitive Condition: A Population-Based Descriptive Study in Osaka, Japan.

BackgroundAmbulatory care sensitive conditions (ACSCs) are defined as clinical conditions for which the risk of emergency hospital admission can be reduced by timely and effective ambulatory care. However, the actual status of patients with ACSCs who are transported by ambulance and their outcomes have not been fully elucidated. The purpose of this study was to reveal characteristics and outcomes of patients with ACSCs who were transported by ambulance using population-based registry data in Osaka, Japan.MethodsThis descriptive epidemiological study was conducted in the 5-year period from January 2016 to December 2020, and included patients who were transported by ambulance due to sudden illness. In this study, ACSC was further classified into acute ACSCs, chronic ACSCs, and preventable ACSCs based on the ICD-10. The number of patients transported by ambulance for ACSCs per 100,000 population in each age group was calculated for each year. In addition, Poisson regression models were used to assess the trend in the number of ACSCs patients transported by ambulance.ResultsA total of 1,572,152 patients were included in this study (acute ACSCs, n = 69,621; chronic ACSCs, n = 12,250; preventable ACSCs, n = 96,036; and non-ACSCs, n = 1,394,245). The overall median age was 71 years (95% confidence interval [CI], 46-92). Patients with acute ACSCs (median age: 76 years [IQR: 60-84]) and chronic ACSCs (median age: 80 years [IQR: 72-87]) were older, while patients with preventable ACSCs were younger (median age: 66 years [95%CI: 3-81]) and included a high proportion of children (33.3%, 32,002/96,036). Regarding the outcome after treatment at the emergency department, 42.6% (670,392/1,572.152) of patients were hospitalized, while 82.3% (10,079/12,250) of patients with chronic ACSCs were hospitalized. No change was observed in adults (P = 0.001) or elderly (age ≥65 years) individuals (P = 0.376) with preventable ACSCs, however, among children, the number increased until 2019 (732.5) and then decreased in 2020 (371.8) (P = 0.392).ConclusionIn this study, patients with chronic ACSCs were predominantly elderly, while patients with preventable ACSCs were polarized between children and the elderly. Among patients with preventable ACSCs, there was no change over time in adults and children, but there was a marked decrease among the elderly after 2020.

Trend of hospitalizations for ambulatory care sensitive conditions and related aspects in Sergipe, 2010 to 2019

Objective: To analyze the trend of hospitalization rates for ambulatory care-sensitive conditions (HACSC) in Sergipe and its seven health regions between 2010 and 2019, correlating with financial investments in health and primary care, strategy coverage of family health, and the number of hospital beds. Methods: This is an ecological time-series study trend with secondary data from the Ministry of Health. The trend verification was done by segmented linear analysis and the correlation between the variables by Spearman's correlation. Results: HACSC in the state of Sergipe showed a trend towards stability. In the Nossa Senhora do Socorro region, an increasing rate trend was identified from 2010 to 2017 and a non-significant decreasing trend from 2017 to 2019, with a negative correlation with per capita investment in PHC. The Itabaiana region showed a trend of reduction in rates from 2010 to 2012, followed by a trend of growth in rates from 2012 to 2020, with no significant correlation with any of the variables. Conclusions: Monitoring HACSC rates and understanding their multifactorial influence are essential since this indicator is helpful in local situational diagnosis and contributes to planning actions.

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.

Systematic Review of Dyadic Interventions for Ambulatory Care Sensitive Conditions: Current Evidence and Key Gaps

ABSTRACT Objectives Identify non-pharmacological interventions to support patient/caregiver dyads with ACSCs; review the effects of dyadic interventions on health services outcomes; and review the effectiveness of dyadic interventions on patient and caregiver biopsychosocial outcomes. Methods A systematic review of randomized controlled trials (RCTs). Results Twenty-six manuscripts representing 20 unique RCTs (Mean N = 154 patients, 140 caregivers) were eligible. Eleven RCTs examined caregiving in patients with HF, seven with T2DM, one with COPD, and one with mixed ACSCs. Dyadic interventions for ACSCs were diverse in terms of length and content, with most including an educational component. Only 4/26 included studies had a low risk of bias. Interventions were most successful at improving quality of life, clinical health outcomes, health behaviors, and health services outcomes, with fewer improvements in patient mental health outcomes, psychosocial outcomes, relationship outcomes, and caregiver outcomes in general. The largest effect sizes were reported from trials focused on T2DM. Conclusions High-quality research with consistent measuring instruments is needed to understand which interventions are associated with improved patient and caregiver outcomes. Clinical Implications There may be clinically relevant benefits to including caregivers in interventions for patients with ACSCs, and clinicians should consider this when devising treatment plans.