Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia

OBJECTIVE: To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS: A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS: There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS: A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study

Emergency department visits for ambulatory care sensitive conditions

Objective: To describe emergency department visits for ambulatory care sensitive conditions. Method: Exploratory, descriptive, ecological, quantitative study. From January 2015 to December 2016, was accessed the database with information of visits performed in an emergency department located in the region of Campo Limpo, municipality of São Paulo. A 99% confidence interval was considered for the incidence of visits with identification of ambulatory care sensitive conditions, and a margin of error of 0.4%. The analyzes were performed with use of the statistical package SPSS. Results: We found 434,883 visits, of which 17.1% were due to ambulatory care sensitive conditions, mostly of women and children up to 4 years of age. The reason for most visits were ear, nose and throat infections (45.4%). There was a higher chance of visits for the indicator in chronic patients (p<0.001). Conclusion: This study demonstrated the emergency department ambulatory care sensitive conditions visits that may indicate poor access to primary care

A relação entre a atenção primária à saúde e as internações por condições sensíveis à atenção ambulatorial nos municípios mineiros

The first paper examines the relationship between primary health care and hospitalizations for ambulatory care sensitive conditions. We apply a hierarchical model and Ordinary Least Square by age groups. Results suggest that primary health care provided by municipalities does not affect potentially preventable hospitalization episodes. This result may reflect problems in the quality of the health care service. Supply of hospital beds per capita has a positive effect on the (probability of) hospitalizations for ambulatory care sensitive conditions.Primary health care, Hospitalizations for ambulatory care sensitive conditions, Public health

Patient Perceptions of Their Doctors and Hospitalization among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease

The objectives for this study were to determine one-year incidence of ambulatory care-sensitive hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) in a Medicare population, to assess association between patient perceptions of their doctors and COPD ambulatory care-sensitive hospitalization, and to assess association between patient perceptions of their doctors and COPD-related hospitalization. An observational, retrospective cohort study was conducted using data from the 2007 to 2012 Medicare Current Beneficiary Survey (MCBS). Patient perceptions of their doctor and hospitalization were assessed during the study period, defined as 12 months following the year in which COPD diagnosis was identified. Individuals were included if they had a diagnosis of COPD, had continuous coverage in Medicare Part A and Medicare Part B during the 12-month study period and the preceding year, and had identified a usual source of care. Individuals were excluded if they had any missing data on items used to create the patient perceptions of doctors index, had a proxy responder, or had a diagnosis of Alzheimer’s disease or dementia. Among 2,306 Medicare beneficiaries who met study criteria, 52 percent were 75 years or older, 54 percent were women, and 86 percent were White. A patient perception of their doctors index was created using MCBS survey items. Individuals with an overall score for the patient perceptions of their doctors scale greater or equal to the median value were categorized as having positive perceptions of their doctors, while those with an overall score below the median value were categorized as having less than positive perceptions of their doctors. One-year incidence of COPD ambulatory care-sensitive hospitalizations was 4.1 percent (95% CI=3.3% to 4.9%). Association between patient perceptions of their doctors and COPD ambulatory care-sensitive hospitalization risk was assessed using multivariate logistic regression models, adjusted for covariates selected from stepwise procedure. The associations between patient perceptions of their doctors and number of COPD ambulatory care-sensitive hospitalizations, COPD ambulatory care-sensitive hospital days, or COPD ambulatory care-sensitive hospitalization expenditures were assessed using multivariate generalized linear models, adjusted for covariates selected from stepwise procedure. Similar models were developed to assess associations between patient perceptions of their doctors and COPD-related hospitalization outcomes. No association was found between patient perceptions of their doctors and COPD ambulatory care-sensitive hospitalization outcomes. However, multivariate models revealed that oxygen users who had less than positive perceptions of their doctors were more likely to have a COPD-related hospitalization (odds ratio=1.73, p=0.010) and had more COPD-related hospitalizations (average marginal effect=0.155, p=0.028) as compared to those who had positive perceptions of their doctors

Using geographic variation in unplanned ambulatory care sensitive condition admission rates to identify commissioning priorities:an analysis of routine data from England

Objectives To use geographic variation in unplanned ambulatory care sensitive condition admission rates to identify the clinical areas and patient subgroups where there is greatest potential to prevent admissions and improve the quality and efficiency of care. Methods We used English Hospital Episode Statistics data from 2011/2012 to describe the characteristics of patients admitted for ambulatory care sensitive condition care and estimated geographic variation in unplanned admission rates. We contrasted geographic variation across admissions with different lengths of stay which we used as a proxy for clinical severity. We estimated the number of bed days that could be saved under several scenarios. Results There were 1.8 million ambulatory care sensitive condition admissions during 2011/2012. Substantial geographic variation in ambulatory care sensitive condition admission rates was commonplace but mental health care and short-stay (&lt;2 days) admissions were particularly variable. Reducing rates in the highest use areas could lead to savings of between 0.4 and 2.8 million bed days annually. Conclusions Widespread geographic variations in admission rates for conditions where admission is potentially avoidable should concern commissioners and could be symptomatic of inefficient care. Further work to explore the causes of these differences is required and should focus on mental health and short-stay admissions. </jats:sec

Avoiding hospitalisation: ambulatory care sensitive conditions

This RESEARCH ROUNDup examines the scope of ambulatory care sensitive conditions (ACSC) in Australia, and their reliability as a measure of primary health care (PHC) performance. Avoidable hospitalisation statistics for Australia, Victoria and New South Wales are presented. Complications of diabetes are the most common ACSCs encountered in Australia. Rurality and socio-economic disadvantage are linked to avoidable hospitalisation

Differential Effects of Race and Poverty on Ambulatory Care Sensitive Conditions

This study is a continuation of an earlier study that examined hospitalization rates for ambulatory care sensitive (ACS) conditions, as a proxy for quality of care, and found evidence of a racial disparity among African American and White Medicare beneficiaries. The current study sought to determine whether neighborhood socioeconomic status (SES) explained this disparity. Differences in rates of ACS hospitalizations by race were assessed using Cochran-Mantel Haenszel tests and Poisson regression. Unadjusted rate ratios for ACS hospitalization for African Americans vs. Whites were found to be higher in low poverty areas (rate ratio (RR)=1.13; 95% CI (1.08, 1.17)) than in high poverty areas (RR=0.97; 95% CI (0.89, 1.05)). After controlling for various indicators of area SES in multivariate analyses race differences in ACS hospitalization rates persisted. Rural neighborhoods and those with higher percent of non-high school graduates were associated with greater risk of ACS hospitalizations

Emergency Department and Inpatient Hospital Use by Medicare Beneficiaries in Patient-Centered Medical Homes

Study objectivePatient-centered medical homes are primary care practices that focus on coordinating acute and preventive care. Such practices can obtain patient-centered medical home recognition from the National Committee for Quality Assurance. We compare growth rates for emergency department (ED) use and costs of ED visits and hospitalizations (all-cause and ambulatory-care-sensitive conditions) between patient-centered medical homes recognized in 2009 or 2010 and practices without recognition.MethodsWe studied a sample of US primary care practices and federally qualified health centers: 308 with and 1,906 without patient-centered medical home recognition, using fiscal year 2008 to 2010 Medicare fee-for-service data. We assessed average annual practice-level payments per beneficiary for ED visits and hospitalizations and rates of ED visits and hospitalizations (overall and ambulatory-care-sensitive condition) per 100 beneficiaries before and after patient-centered medical home recognition, using a difference-in-differences regression model comparing patient-centered medical homes and propensity-matched non–patient-centered medical homes.ResultsComparing patient-centered medical home with non–patient-centered medical home practices, the rate of growth in ED payments per beneficiary was $54 less for 2009 patient-centered medical homes and$48 less for 2010 patient-centered medical homes relative to non–patient-centered medical home practices. The rate of growth in all-cause and ambulatory-care-sensitive condition ED visits per 100 beneficiaries was 13 and 8 visits fewer for 2009 patient-centered medical homes and 12 and 7 visits fewer for 2010 patient-centered medical homes, respectively. There was no hospitalization effect.ConclusionFrom 2008 to 2010, outpatient ED visits increased more slowly for Medicare patients being treated by patient-centered medical home practices than comparison non–patient-centered medical homes. The reduction was in visits for both ambulatory-care-sensitive and non–ambulatory-care-sensitive conditions, suggesting that steps taken by practices to attain patient-centered medical home recognition such as improving care access may decrease some of the demand for outpatient ED care

what conditions make inter-country comparisons possible?

Hospitalizations for ambulatory care sensitive conditions have been extensively used in health services research to assess access, quality and performance of primary health care. Inter-country comparisons can assist policy-makers in pursuing better health outcomes by contrasting policy design, implementation and evaluation. The objective of this study is to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing these types of hospitalizations across countries. A conceptual framework for inter-country comparisons was drawn based on a review of 18 studies with inter-country comparison of ambulatory care sensitive conditions hospitalizations. The dimensions include methodological choices; population's demographic, epidemiologic and socio-economic profiles and features of the health services and system. Main factors include access and quality of primary health care, availability of health workforce and health facilities, health interventions and inequalities. The proposed framework can assist in designing studies and interpreting findings of inter-country comparisons of ambulatory care sensitive conditions hospitalizations, accelerating learning and progress towards universal health coverage.publishersversionpublishe

Os internamentos devidos a Ambulatory Care Sensitive Conditions em Portugal : caracterização e variabilidade espacial em 2013 e 2014

Trabalho Final do Curso de Especialização em Administração HospitalarRESUMO - Contexto Os internamentos devidos a Ambulatory Care Sensitive Conditions são internamentos cuja probabilidade de ocorrerem pode ser diminuída através da intervenção apropriada, atempada e efetiva dos cuidados de saúde primários pelo que, têm sido amplamente utilizados como um indicador da qualidade dos cuidados de saúde prestados neste nível de cuidados. No entanto, são vários os fatores que contribuem para a ocorrência deste tipo de internamentos como o nível socioeconómico, a faixa etária, as comorbilidades associadas e a distância ao hospital. Objetivo O presente trabalho tem como objetivo estudar a variabilidade intrarregional da ocorrência de internamentos devidos a Ambulatory Care Sensitive Conditions. Metodologia Com recurso à Base de Dados de Morbilidade Hospitalar, e com base na metodologia espanhola desenvolvida por Caminal e outros, foram identificados os internamentos devidos a Ambulatory Care Sensitive Conditions ocorridos entre 2013 e 2014 nas 23 regiões em análise. Resultados No período em análise, o número de internamentos devidos a Ambulatory Care Sensitive Conditions sofreu um aumento de 11,4%. As diferenças registadas entre 2013 e 2014 no que diz respeito à percentagem de internamentos devidos a Ambulatory Care Sensitive Conditions foram estatisticamente significativas em 8 das 23 regiões em análise. A nível nacional, os custos decorrentes dos internamentos devidos a Ambulatory Care Sensitive Conditions sofreram um aumento de 9,2%. Conclusão A caracterização minuciosa das regiões tornará possível um levantamento da informação respeitante a fatores socioeconómicos, à densidade populacional, à distância ao hospital mais próximo e à prevalência das doenças, no sentido de alargar o conhecimento existente acerca das causas relacionadas com os internamentos devidos a Ambulatory Care Sensitive Conditions.ABSTRACT - Background Hospitalizations due to Ambulatory Care Sensitive Conditions can be reduced by appropriate, timely and effective intervention of primary health care. These hospitalizations have been widely used as an indicator of the quality of care. However, there are some reasons which can explain the occurrence of this kind of hospitalizations like socioeconomic status, age, comorbidities and the distance to the hospital. Objective The purpose of this paper is to study the occurrence of hospitalizations due to Ambulatory Care Sensitive Conditions between geographic areas. Methods The database used in the study was data about Diagnostic-Related Groups. Hospitalizations due to Ambulatory Care Sensitive Conditions occured between 2013 e 2014 in the 23 geographic areas were identified by the spanish methodology developed by Caminal and colleagues. Results During the study period, there was a growth of 11,4% on hospitalizations due to Ambulatory Care Sensitive Conditions. The differences identified on the percentage of hospitalizations due do Ambulatory Care Sensitive Conditions between 2013 and 2014 were statistically significant in 8 out of 23 geographic areas. During the study period, there was a growth of 9,2% on costs related to hospitalizations due to Ambulatory Care Sensitive Conditions. Conclusion The detailed study of the geographic areas will enable a survey of information concerning the socio-economic factors, population density, distance to the nearest hospital and the prevalence of diseases in order to extend the knowledge about the reasons related to the hospitalizations due to Ambulatory Care Sensitive Conditions.N/