Hospitalization for Ambulatory Care-Sensitive Conditions: A Method for Comparative Access and Quality Studies Using Routinely Collected Statistics

Article excerpt


Background Appropriate and timely provision of ambulatory care is an important factor in maintaining population health and in avoiding unnecessary hospital use. This article describes conditions for which hospitalization rates have a strong and inverse relationship to access to high-quality ambulatory care.

Methods Three panels of Canadian physicians following different consensus techniques selected conditions for which the relative risk of hospitalization is inversely related to ambulatory care access.

Principal Findings: All panels identified asthma, angina pectoris, congestive heart failure, otitis media, gastric ulcer, pelvic inflammatory disease, malignant hypertension, and immunization-- preventable infections as ambulatory care-- sensitive admissions. These conditions strongly overlap with lists developed for similar purposes in the U.S. and England.

Interpretation: Ambulatory care-sensitive conditions represent an intermediate health outcome. They are distinct from inappropriate hospitalizations. They may be useful for measuring the impact of health care policy, and for performance measurement or audit.

ABREGE Contexte: La prestation individualisee et opportune de coins ambulatoires est un facteur important pour maintenir la sang de la population et eviter les scjours inutiles a l'hopital. Notre article decrit les stats de sante dont les taux d'hospitalisation presentent une forte relation inverse avec l'acces a des soins ambulatoires de haute qualite.

Methode : Trois grouper de medecins canadiens suivant differentes techniques de concertation ont selectionne les etats de sante dont le risque relatif d'hospitalisation etait en relation inverse avec l'acces aux coins ambulatoires.

Principales constatations : Les trois groupes ont determine que les admissions de cas d'asthme, d'angine de poitrine, d'insuffisance cardiaque globale, d'otite moyenne, d'ulcere gastrique, d'infection pelvienne, d'hypertension artcrielle maligne et d'infections evitables par la vaccination etaient sensibles aux coins ambulatoires. Cette liste presente d'importants recoupements avec celles dresses aux EtatsUnis et en Angleterre.

Interpretation: Les etats de sante sensibles aux soins ambulatoires sont a classer parmi les resultats de sante a moyen terme. Il faut les distinguer des hospitalisations inutiles. Ils peuvent servir a mesurer les incidences des politiques de coins de sante, ainsi qu a des fins de verification ou de mesure du rendement.

Access to health care may be defined as the ability to obtain and benefit from care. Universal access to necessary care remains one of the chief goals of the health-care system in Canada.1 Ambulatory care-- sensitive conditions (ACSC) are a new negative indicator of access. The rate of hospitalization for ACSC is higher in communities with poor access to ambulatory care. This paper describes the development, using consensus panels, of a Canadian set of ACSC and compares them to similar categories of care developed elsewhere.2-4


Questionnaire development

We identified nearly 400 4-digit International Classification of Diseases 9th Revision (ICD-9) diagnosis codes and over 150 3-digit Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures (CCP) procedure codes with a potential relationship to health care access in English and French language articles, abstracts, and other source materials between 1972 to 1997 using the Medline, science citation, CINAHL, and Healthstar electronic databases, and manual searches of several clinical and public health journals. We excluded rare diagnoses and procedures (incidence of hospitalization <0.25/100,000 population in Ontario, 1992) from further consideration. We organized remaining potential ACSC into 33 diagnostic and 18 procedural groupings based on etiology, typical severity on admission to hospital, and common treatments. …