title: [Hospitalisations for ambulatory care sensitive conditions in Germany].
abstract: BACKGROUND
  On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for access to and quality of ambulatory care. The German Council of Health Experts proposes hospitalisation rates for diabetes, asthma, hypertension and chronic heart failure as ACSC measures in Germany.
  
  
  OBJECTIVE
  This article focuses on regional differences in ACSC rates, describes the longitudinal development and explores potential determinants.
  
  
  METHODS
  Descriptive statistical analyses as well as spatial regression analyses were performed on the basis of Federal Statistical Office data. We included data from the hospital and physician statistics. Bayesian spatial regression techniques were used.
  
  
  RESULTS
  Whereas hospitalisation rates for asthma decreased between 2000 and 2010, hospitalisation rates for diabetes, hypertension and chronic heart failure increased. Comparing age-adjusted ACSC rates across all German federal states, the Eastern states as well as Saarland showed significantly higher ACSC rates over time. This observation can in part be explained by physician density and the number of hospital beds.
  
  
  CONCLUSIONS
  Although not all ACSC hospitalisations can be avoided, these results display a potential for optimising care across healthcare sectors in Germany.
authors: Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg. Electronic address: tobias.freund@med.uni-heidelberg.de.
authors: Tobias
authors: T
authors: Freund
authors: AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen.
authors: Günther
authors: G
authors: Heller
authors: Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg; AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen.
authors: Joachim
authors: J
authors: Szecsenyi
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001249:Asthma / Q000453:epidemiology / Q000628:therapy; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D005858:Germany; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D009313:National Health Programs / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data
keywords: Ambulante Versorgung; Ambulatory care sensitive conditions; Qualitätsindikatoren; avoidable hospitalisations; chronic care; chronische Krankheiten; quality indicators; vermeidbare Krankenhausaufenthalte