Hospitalization for ambulatory care-sensitive conditions: a method for comparative access and quality studies using routinely collected statistics.
BACKGROUND
Appropriate and timely provision of ambulatory care is an important factor in maintaining population health and in avoiding unneccessary 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.


RESULTS
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.


CONCLUSIONS
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.
Brown
A D
AD
Department of Public Health and Primary Care, University of Oxford. adalsteinn.brown@utoronto.ca
Goldacre
M J
MJ
Hicks
N
N
Rourke
J T
JT
McMurtry
R Y
RY
Brown
J D
JD
Anderson
G M
GM
D000553:Ambulatory Care / Q000592:standards*; D000787:Angina Pectoris / Q000628:therapy; D001249:Asthma / Q000628:therapy; D002170:Canada; D003625:Data Collection / Q000379:methods*; D003697:Delphi Technique; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards*; D006302:Health Services Research / Q000379:methods*; D006333:Heart Failure / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006974:Hypertension, Malignant / Q000628:therapy; D007239:Infections / Q000628:therapy; D008297:Male; D008485:Medical Audit; D010033:Otitis Media / Q000628:therapy; D017063:Outcome Assessment, Health Care; D000292:Pelvic Inflammatory Disease / Q000628:therapy; D011787:Quality of Health Care; D012307:Risk Factors; D013276:Stomach Ulcer / Q000628:therapy; D014611:Vaccination / Q000592:standards