title: Ambulatory Care Sensitive Hospitalizations among Medicaid Beneficiaries with Chronic Conditions.
abstract: OBJECTIVE
  This study examined the relationship between ambulatory care sensitive hospitalizations (ACSH) and patient-level and county-level variables.
  
  
  METHODS
  Utilizing a retrospective cohort approach, multi-state Medicaid claims data from 2007-2008 was used to examine ACSH at baseline and follow-up periods. The study cohort consisted of adult, non-elderly Medicaid beneficiaries with chronic physical conditions, who were continuously enrolled in fee-for-service programs, not enrolled in Medicare, and did not die during the study period (N=7,021). The dependent variable, ACSH, was calculated in the follow-up year using an algorithm from the Agency for Healthcare Research and Quality algorithm. Patient-level (demographic, health status, continuity of care) and county-level (density of healthcare providers and facilities, socio-economic characteristics, local economic conditions) factors were included as independent variables. Multivariable logistic regression models were used to examine the relationship between ACSH and independent variables.
  
  
  RESULTS
  In this study population, 8.2% had an ACSH. African-Americans were more likely to have an ACSH [AOR=1.55, 95% CI 1.16, 2.07] than Caucasians. Adults with schizophrenia were more likely to have an ACSH, compared to those without schizophrenia [AOR=1.54, 95% CI 1.16, 2.04]. Residents in counties with a higher number of community mental health centers [AOR=0.88, 95% CI 0.80, 0.97] and rural health centers [AOR=0.98, 95% CI 0.95, 0.99] were less likely to have an ASCH.
  
  
  CONCLUSIONS
  Programs and interventions designed to reduce the risk of ACSH may be needed to target specific population subgroups and improve healthcare infrastructure.
authors.affiliation: a School of Pharmacy , West Virginia University , Morgantown , WV , USA.
authors.forename: Ishveen
authors.initials: I
authors.lastname: Chopra
authors.affiliation: b Department of Pharmaceutical Systems and Policy , U.S. Department of Health & Human Services , Washington , DC, District of Columbia , USA.
authors.forename: Tricia Lee
authors.initials: TL
authors.lastname: Wilkins
authors.affiliation: a School of Pharmacy , West Virginia University , Morgantown , WV , USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Ambulatory care sensitive hospitalization; County-level factors; Medicaid; Quality of care