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BMC Health Services Research
Published in: BMC Health Services Research 1/2012

Open Access 01-12-2012 | Research article

Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia

Authors: Zahid Ansari, Syed Imran Haider, Humaira Ansari, Tanyth de Gooyer, Colin Sindall

Published in: BMC Health Services Research | Issue 1/2012

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Abstract

Background

Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04.

Methods

Hospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED) and Accessibility/Remoteness Index of Australia (ARIA). Univariate and multiple logistic regressions were performed for both adult (age 18+ years) and paediatric (age <18 years) groups, reporting odds ratios (OR) and 95% confidence intervals (CI) for a number of predictors of ACSCs admissions compared to non-ACSCs admissions.

Results

Predictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively.

Conclusions

Disadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population.
Literature
1.
Ansari MZ, Henderson T: The Victorian ambulatory care sensitive conditions study: opportunities for targeting public health and health services interventions. 2002, Melbourne, Victoria: Department of Human Services
2.
Billings J, Zeitel L, Lukomnik J, Carey T, Blank A, Newman L: Impact of socioeconomic status on hospital use in New york city. Heal Aff. 1993, 12 (1): 162-173. 10.1377/hlthaff.12.1.162.CrossRef
3.
Access to health care in America. Edited by: Millman ML. 1993, Washington, DC: Institute of Medicine, National Academy Press
4.
Weissman JS, Gastonis C, Epstein AM: Rates of avoidable hospitalization by insurance status in massachusetts and maryland. JAMA. 1992, 268: 2388-2394. 10.1001/jama.1992.03490170060026.CrossRefPubMed
5.
Friedman B, Basu J: Health insurance, primary care, and preventable hospitalization of children in a large state. Am J Manag Care. 2001, 7 (5): 473-481.PubMed
6.
Billings J, Anderson GM, Newman LS: Recent findings on preventable hospitalizations. Heal Aff. 1996, 15 (3): 239-249. 10.1377/hlthaff.15.3.239.CrossRef
7.
Ansari Z, Laditka JN, Laditka SB: Access to health care and hospitalization for ambulatory care sensitive conditions. Med Care Res Rev. 2006, 63 (6): 719-741. 10.1177/1077558706293637.CrossRefPubMed
8.
Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A: Preventable hospitalizations and access to health care. JAMA. 1995, 274 (4): 305-311. 10.1001/jama.1995.03530040033037.CrossRefPubMed
9.
Laditka JN, Laditka SB, Mastanduno MP: Hospital utilization for ambulatory care sensitive conditions: health outcome disparities associated with race and ethnicity. Soc Sci Med. 2003, 57 (8): 1429-1441. 10.1016/S0277-9536(02)00539-7.CrossRefPubMed
10.
Ackland MJ, Choi BCK, Ansari Z: Indicators and public health policy. Aust J Prim Health. 2005, 11 (2): 1-3.
11.
Ansari Z, Carson N, Serraglio A, Barbetti T, Cicuttini F: The victorian ambulatory care sensitive conditions study: reducing demand on hospital services in victoria. Aust Health Rev. 2002, 25 (2): 71-77. 10.1071/AH020071.CrossRefPubMed
12.
Cockley DE: The effects of subsidized primary care centers on avoidable hospitalization in west Virginia communities during 1988-1992. 1996, Chapel Hill, NC: University of North Carolina at Chapel Hill
13.
DHCFP: Improving primary care: using preventable hospitalization as an approach. 1995, Boston, MA: Division of Health Care Finance and Policy (DHCFP), State of Massachusetts
14.
Foland J: Avoidable hospitalizations: an indicator of inadequate primary care. Issue brief #2000-1. 2000, CT, USA: Division of Policy, Planning, and Analysis, Department of Public Health
15.
Jones-Vessey K: Potentially avoidable hospitalizations in north Carolina, 1997, SCHS studies no. 118. 1999, Raleigh, NC, USA: North Carolina Public Health, State Center for Health Statistics
16.
NHDHHS: New Hampshire regional health profiles: healthy New Hampshire 2010. 2001, Concord, New Hampshire, USA: New Hampshire Department of Health and Human Services (NHDHHS)
17.
Ricketts TC, Randolph R, Howard HA, Pathman D, Carey T: Hospitalization rates as indicators of access to primary care. Health Place. 2001, 7 (1): 27-38. 10.1016/S1353-8292(00)00035-6.CrossRefPubMed
18.
Schreiber S, Zielinski T: The meaning of ambulatory care sensitive admissions: urban and rural perspectives. J Rural Health. 1997, 13 (4): 276-284. 10.1111/j.1748-0361.1997.tb00970.x.CrossRefPubMed
19.
Shukla RK, Pestian JP: Small area analysis of primary care sentinel events in Virginia. 1996, Richmond, Virginia, USA: Virginia Commonwealth, Williamson Institute for Health Studies
20.
Silver MP, Babitz ME, Magill MK: Ambulatory care sensitive hospitalization rates in the aged medicare population in utah, 1990 to 1994: a rural-urban comparison. J Rural Health. 1997, 13 (4): 285-294. 10.1111/j.1748-0361.1997.tb00971.x.CrossRefPubMed
21.
Ansari Z: The concept and usefulness of ambulatory care sensitive conditions as indicators of quality and access to primary health care. Aust J Prim Health. 2007, 13 (3): 91-110. 10.1071/PY07043.CrossRef
22.
Guo L, MacDowell M, Levin L, Hornung RW, Linn S: How are age and payors related to avoidable hospitalization conditions?. Manag Care Q. 2001, 9 (4): 33-42.PubMed
23.
Kozak LJ, Hall MJ, Owings MF: Trends in avoidable hospitalizations, 1980-1998. Health Aff (Millwood). 2001, 20 (2): 225-232. 10.1377/hlthaff.20.2.225.CrossRef
24.
Pappas G, Hadden WC, Kozak LJ, Fisher GF: Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health. 1997, 87: 811-816. 10.2105/AJPH.87.5.811.CrossRefPubMedPubMedCentral
25.
Casanova C, Colomer C, Starfield B: Pediatric hospitalization due to ambulatory care-sensitive conditions in valencia (spain). Int J Qual Health Care. 1996, 8 (1): 51-59. 10.1093/intqhc/8.1.51.CrossRefPubMed
26.
Basu J, Friedman B, Burstin H: Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: a New approach. Med Care. 2002, 40 (12): 1260-1269. 10.1097/00005650-200212000-00013.CrossRefPubMed
27.
Shi L, Samuels ME, Pease M, Bailey WP, Corley EH: Patient characteristics associated with hospitalizations for ambulatory care sensitive conditions in south carolina. South Med J. 1999, 92 (10): 989-998. 10.1097/00007611-199910000-00009.CrossRefPubMed
28.
Shi L, Lu N: Individual sociodemographic characteristics associated with hospitalization for pediatric ambulatory care sensitive conditions. J Health Care Poor Underserved. 2000, 11 (4): 373-384. 10.1353/hpu.2010.0732.CrossRefPubMed
29.
Laditka SB, Laditka JN: Geographic variation in preventable hospitalization of older women and men: implications for access to primary health care. J Women Aging. 1999, 11 (4): 43-56. 10.1300/J074v11n04_04.CrossRefPubMed
30.
Basu J: Preventable hospitalizations and medicare managed care: a small area analysis. Am J Manag Care. 2012, 18 (8): e280-e290.PubMed
31.
Agha MM, Glazier RH, Guttmann A: Relationship between social inequalities and ambulatory care-sensitive hospitalizations persists for up to 9 years among children born in a major canadian urban center. Ambul Pediatr. 2007, 7 (3): 258-262. 10.1016/j.ambp.2007.02.005.CrossRefPubMed
32.
Purdy S, Griffin T, Salisbury C, Sharp D: Emergency admissions for coronary heart disease: a cross-sectional study of general practice, population and hospital factors in england. Public Health. 2011, 125 (1): 46-54. 10.1016/j.puhe.2010.07.006.CrossRefPubMed
33.
Johnson PJ, Ghildayal N, Ward AC, Westgard BC, Boland LL, Hokanson JS: Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions. Med Care. 2012, 50 (12): 1020-1028. 10.1097/MLR.0b013e318270bad4.CrossRefPubMed
34.
Radley DC, Schoen C: Geographic variation in access to care–the relationship with quality. N Engl J Med. 2012, 367 (1): 3-6. 10.1056/NEJMp1204516.CrossRefPubMed
35.
Purdy S, Griffin T, Salisbury C, Sharp D: Emergency respiratory admissions: influence of practice, population and hospital factors. J Health Serv Res Policy. 2011, 16 (3): 133-140. 10.1258/jhsrp.2010.010013.CrossRefPubMed
36.
Garg A, Probst JC, Sease T, Samuels ME: Potentially preventable care: ambulatory care-sensitive pediatric hospitalizations in south carolina in 1998. South Med J. 2003, 96 (9): 850-858. 10.1097/01.SMJ.0000083853.30256.0A.CrossRefPubMed
37.
Laditka JN: Hazards of hospitalization for ambulatory care sensitive conditions among older women: evidence of greater risks for african americans and hispanics. Med Care Res Rev. 2003, 60 (4): 468-495. 10.1177/1077558703257369.CrossRefPubMed
38.
Basu J, Friedman B: Preventable illness and out-of-area travel of children in New york counties. Health Econ. 2001, 10 (1): 67-78. 10.1002/1099-1050(200101)10:1<67::AID-HEC562>3.0.CO;2-K.CrossRefPubMed
39.
Culler SD, Parchman ML, Przybylski M: Factors related to potentially preventable hospitalizations among the elderly. Med Care. 1998, 36 (6): 804-817. 10.1097/00005650-199806000-00004.CrossRefPubMed
40.
DHS: The Victorian admitted episodes dataset: an overview. 2001, Department of Human Servcies, Acute Health Division, Melbourne, Victoria
41.
NCCH: ICD-10-AM: Australian coding standards, volume 5 of the international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). 2000, Sydney: National Centre for Classification in Health (NCCH), Faculty of Health Sciences, The University of Sydney, 2
42.
Ansari MZ, Simmons D, Hart WG, Cicuttini F, Carson NJ, Brand NIAJ, Ackland MJ, Lang DJ: Preventable hospitalisations for diabetic complications in rural and urban victoria. Australian Journal of Primary Health-Interchange. 2000, 6 (3&4): 261-272.CrossRef
43.
Ansari Z, Barbetti T, Carson NJ, Auckland MJ, Cicuttini F: The victorian ambulatory care sensitive conditions study: rural and urban perspectives. Soz- Praventivmed. 2003, 48 (1): 33-43. 10.1007/s000380300004.CrossRefPubMed
44.
Purdy S, Griffin T, Salisbury C, Sharp D: Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health. 2009, 123 (2): 169-173. 10.1016/j.puhe.2008.11.001.CrossRefPubMed
45.
ABS: 2001 Census of population and housing. Number of persons (not including overseas visitors) by sex and five year age groups, by birthplace of individual, by area of usual residence (Victoria and Australia). 2005, Canberra: Australian Bureau of Statistics (ABS
46.
Hugo GJ, Bamford E, Dunne L: Accessibility remoteness index of Australia (ARIA). department of health and aged care occassional papers series No. 6, Commonwealth department of health and aged care. 1999, Canberra: ACT
47.
Snijders TAB, Bosker RJ: Multilevel analysis. 1999, London: Sage Publications
48.
Rabe-Hesketh S, Pickles A, Skrondal A: GLLAMM: a general class of multilevel models and a stata program. Multilevelling Modelling Newsletter. 2001, 13: 17-23.
49.
Rabe-Hesketh S, Pickles A, Skrondal A: GLLAMM manual, technical report 2001/01. 2001, London: Institute of Psychiatry, King's College, University of London
50.
Oster A, Bindman AB: Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations. Med Care. 2003, 41 (2): 198-207.PubMed
51.
Ansari Z, Stevenson E: The Victorian ambulatory care sensitive conditions study: diabetes complications in Victoria, 2001-02. 2004, Melbourne: Victorian Government: Department of Human Services (DHS)
52.
CDC: National diabetes fact sheet: general information and national estimates on diabetes in the united states, 2003. 2004, Atlanta, GA: Department of Health and Human Services, Centers for Disease control and Prevention (CDC)
53.
DHS: Diabetes prevention and management - a strategic framework for Victoria 2007-2010. 2007, Melbourne: Victorian Government: Department of Human Services (DHS)
54.
Ansari Z: The Victorian ambulatory care sensitive conditions study: preliminary analyses. 2001, Melbourne, Victoria: Department of Human Services, Public Health Division
55.
DHS: Improving Victoria's oral health. 2007, Melbourne: Department of Human Services (DHS)
56.
Ansari Z, Carson NJ, Serraglio A, Barbetti T: The Victorian ambulatory care sensitive conditions study: opportunities for targeted interventions. 2001, Melbourne, Victoria: Department of Human Services, Public Health Division
57.
Oddone EZ, Weinberger M, Giobbie-Hurder A, Landsman P, Henderson W: Enhanced access to primary care for patients with congestive heart failure veterans affairs cooperative study group on primary care and hospital readmission. Eff Clin Pract. 1999, 2 (5): 201-209.PubMed
58.
Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM: A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995, 333 (18): 1190-1195. 10.1056/NEJM199511023331806.CrossRefPubMed
59.
Hughes SL, Weaver FM, Giobbie-Hurder A, Manheim L, Henderson W, Kubal JD, Ulasevich A, Cummings J: Effectiveness of team-managed home-based primary care: a randomized multicenter trial. JAMA. 2000, 284 (22): 2877-2885. 10.1001/jama.284.22.2877.CrossRefPubMed
60.
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS: Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999, 281 (7): 613-620. 10.1001/jama.281.7.613.CrossRefPubMed
61.
Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS: Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004, 52 (5): 675-684. 10.1111/j.1532-5415.2004.52202.x.CrossRefPubMed
62.
Institute of medicine: access to health care in America. Edited by: Millman M. 1993, Washington: National Academies Press
63.
Gibbons DC, Bindman AB, Soljak MA, Millett C, Majeed A: Defining primary care sensitive conditions: a necessity for effective primary care delivery?. J R Soc Med. 2012, 105 (10): 422-428. 10.1258/jrsm.2012.120178.CrossRefPubMedPubMedCentral
64.
Caminal J, Starfield B, Sanchez E, Casanova C, Morales M: The role of primary care in preventing ambulatory care sensitive conditions. Eur J Public Health. 2004, 14 (3): 246-251. 10.1093/eurpub/14.3.246.CrossRefPubMed
65.
Laditka SB, Johnston JM: Preventable hospitalization and avoidable maternity outcomes: implications for access to health services for medicaid recipients. J Health Soc Policy. 1999, 11: 41-55.CrossRefPubMed
66.
Laditka JN, Laditka SB, Probst JC: Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the united states may increase with the level of rurality. Health Place. 2009, 15 (3): 731-740.CrossRefPubMed
67.
Ansari Z: A review of literature on access to primary health care. Aust J Prim Health. 2007, 13 (2): 66-81. 10.1071/PY07025.CrossRef
68.
Schoen C, Osborn R, Huynh PT, Doty M, Davis K, Zapert K, Peugh J: Primary care and health system performance: adults' experiences in five countries. Health Aff (Millwood. 2004, W4-487-503. Suppl Web Exclusives
69.
70.
Australian Institute of Health and Welfare: Australian hospital statistics 2008-09. Health services series no. 34. Cat. no. HSE 84. 2010, Canberra: AIHW
71.
72.
Henderson T, Shepherd J, Sundararajan V: Quality of diagnosis and procedure coding in ICD-10 administrative data. Medical Care. 2006, 44 (11): 1011-1019. 10.1097/01.mlr.0000228018.48783.34.CrossRefPubMed
73.
MacIntyre CR, Ackland MJ, Chandraraj EJ: Accuracy of injury coding in victorian hospital morbidity data. Aust NZ J Public Health. 1997, 21: 779-782.CrossRef
74.
MacIntyre CR, Ackland MJ, Chandraraj EJ, Pilla JE: Accuracy of ICD-9-CM codes in hospital morbidity data. Victoria. Aust NZ J Public Health. 1997, 21: 477-482. 10.1111/j.1467-842X.1997.tb01738.x.CrossRef
Metadata
Title
Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia
Authors
Zahid Ansari
Syed Imran Haider
Humaira Ansari
Tanyth de Gooyer
Colin Sindall
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2012
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-12-475

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