Canadian Journal of Public Health

, Volume 92, Issue 2, pp 155–159 | Cite as

Hospitalization for Ambulatory Care-Sensitive Conditions: A Method for Comparative Access and Quality Studies Using Routinely Collected Statistics

  • Adalsteinn D. Brown
  • Michael J. Goldacre
  • Nicholas Hicks
  • James T. Rourke
  • Robert Y. McMurtry
  • John D. Brown
  • Geoffrey M. Anderson


Background: Appropriate and timely provision of ambulatory care is an important factor in maintaining population health and in avoiding unnecessary 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.

Principal Findings: All panels identified asthma, angina pectoris, congestive heart failure, otitis media, gastric ulcer, pelvic inflammatory disease, malignant hypertension, and immunizationpreventable infections as ambulatory caresensitive admissions. These conditions strongly overlap with lists developed for similar purposes in the U.S. and England.

Interpretation: 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.


Contexte: La prestation individualisée et opportune de soins ambulatoires est un facteur important pour maintenir la santé de la population et éviter les séjours inutiles à l’hôpital. Notre article décrit les états de santé dont les taux d’hospitalisation présentent une forte relation inverse avec l’accès à des soins ambulatoires de haute qualité.

Méthode: Trois groupes de médecins canadiens suivant différentes techniques de concertation ont sélectionné les états de santé dont le risque relatif d’hospitalisation était en relation inverse avec l’accès aux soins ambulatoires.

Principales constatations: Les trois groupes ont déterminé que les admissions de cas d’asthme, d’angine de poitrine, d’insuffisance cardiaque globale, d’otite moyenne, d’ulcère gastrique, d’infection pelvienne, d’hypertension artérielle maligne et d’infections évitables par la vaccination étaient sensibles aux soins ambulatoires. Cette liste présente d’importants recoupements avec celles dressées aux États- Unis et en Angleterre.

Interprétation: Les états de santé sensibles aux soins ambulatoires sont à classer parmi les résultats de santé à moyen terme. Il faut les distinguer des hospitalisations inutiles. Ils peuvent servir à mesurer les incidences des politiques de soins de santé, ainsi qu’à des fins de vérification ou de mesure du rendement.


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  1. 1.
    Government of Canada, Canada Health Act. Ottawa: Government of Canada, 1984;c:C-6.Google Scholar
  2. 2.
    Weissman JS, Gatsonis C, Epstein, AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA 1992; 268:2388–94.CrossRefGoogle Scholar
  3. 3.
    Billings J, et al. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 1993;12:162–73.CrossRefGoogle Scholar
  4. 4.
    Dixon J, Sanderson C, Hunter D. Identifying Conditions for Which an Admission to Hospital is Potentially Avoidable by Effective Ambulatory Care.(unpublished) 1996.Google Scholar
  5. 5.
    Parchman ML, Culler S. Primary care physicians and avoidable hospitalizations. J Fam Pract 1994;39:123–28.PubMedGoogle Scholar
  6. 6.
    Bindman AB, et al. Preventable hospitalizations and access to health care. JAMA 1995;274:305–11.CrossRefGoogle Scholar
  7. 7.
    Wennberg JE, McPherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? N Engl J Med 1984;311(5):295–300.CrossRefGoogle Scholar
  8. 8.
    Roos NP, Wennberg JE, McPherson K. Using diagnosis-related groups for studying variations in hospital admissions. Health Care Financing Review 1988;9:53–62.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Gloor JE, Kisson N, Joubert, GJ. Appropriateness of hospitalization in a Canadian pediatric hospital. Pediatrics 1993;91:70–74.PubMedGoogle Scholar
  10. 10.
    Sackman H. Delphi Assessment: Expert Opinion, Forecasting, and Group Process. Santa Monica, CA: The Rand Corporation, 1974.Google Scholar
  11. 11.
    Brook RH, et al. Diagnosis and treatment of coronary disease: Comparison of doctors’ attitudes in the USA and, UK. Lancet 1988;i:750–53.CrossRefGoogle Scholar
  12. 12.
    Fraser GM, et al. Effect of panel composition on appropriateness ratings. Int J Qual Health Care 1994;6:251–55.CrossRefGoogle Scholar
  13. 13.
    Casanova C, Starfield B. Hospitalizations of children and access to primary care: A cross-national comparison. Int J Health Serv 1995;25:283–94.CrossRefGoogle Scholar
  14. 14.
    Casanova C, Colomer C, Starfield B. Pediatric hospitalizations due to ambulatory care-sensitive conditions in Valencia (Spain). Int J Qual Health Care 1996;8:51–59.PubMedGoogle Scholar
  15. 15.
    Billings J, Anderson GM, Newman, LS. Recent findings on preventable hospitalizations. Health Aff (Millwood) 1996;15:239–49.CrossRefGoogle Scholar
  16. 16.
    Bild D, et al. Sentinel health events surveillance in diabetes - deaths among persons under age 45 with diabetes. J Clin Epidemiol 1988;41:999–1006.CrossRefGoogle Scholar
  17. 17.
    Carter Center of Emory University. Closing the gap: The problem of diabetes mellitus in the United States. Diabetes Care 1985;8:391–406.CrossRefGoogle Scholar
  18. 18.
    Connell, FA. Epidemiologic approach to the identification of problems in diabetes care. Diabetes Care 1985;8:82–86.CrossRefGoogle Scholar
  19. 19.
    National Commission on Diabetes to the Congress of the United States. Report of the National Commission on Diabetes to the Congress of the United States, Assessment of Program Effectiveness at Grady Memorial Hospital. DHEW #77-1031, Part 5, Vol III. Washington, D.C.: US Govt Printing Office, 1975.Google Scholar
  20. 20.
    Williams DRR. Outcome indicators for diabetes services - what do we have and what do we need? Community Medicine 1989;11(1):57–64.Google Scholar
  21. 21.
    Carr W, et al. Sentinel health events as indicators of unmet needs. Soc Sci Med 1989;29:705–14.CrossRefGoogle Scholar
  22. 22.
    Carr W, Zeitel L, Weiss K. Variations in asthma hospitalizations and deaths in New York City. Am J Public Health 1992;82:59–65.CrossRefGoogle Scholar
  23. 23.
    Gonnella JS, Louis DZ, McCord, JJ. The staging concept - an approach to the assessment of outcome of ambulatory care. Med Care 1976;14:13–21.CrossRefGoogle Scholar
  24. 24.
    Wissow LS, et al. Poverty, race, and hospitalization for childhood asthma. Am J Public Health 1988;78:777–82.CrossRefGoogle Scholar
  25. 25.
    Weissman JS, et al. Delayed access to health care: Risk factors, reasons, and consequences. Ann Intern Med 1991;114:325–31.CrossRefGoogle Scholar
  26. 26.
    Starfield B, et al. Costs vs quality in different types of primary care settings. JAMA 1994;272:1903–908.CrossRefGoogle Scholar
  27. 27.
    Connell FA, Day RW, LoGerfo J. Hospitalisation of Medicaid children: Analysis of small area variations in admission rates. Am J Public Health 1981;71:606–13.CrossRefGoogle Scholar
  28. 28.
    Stoddard JJ, St Peter RF, Newacheck, PW. Health insurance status and ambulatory care for children [see comments]. N Engl J Med 1994;330:1421–25.CrossRefGoogle Scholar
  29. 29.
    Wennberg JE, et al. Changes in tonsillectomy rates associated with feedback and review. Pediatrics 1977;59:821–26.PubMedGoogle Scholar
  30. 30.
    Gonnella JS, et al. The problem of late hospitalization: A quality and cost issue. Acad Med 1990;65:314–19.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2001

Authors and Affiliations

  • Adalsteinn D. Brown
    • 1
  • Michael J. Goldacre
    • 1
    • 2
  • Nicholas Hicks
    • 1
  • James T. Rourke
    • 3
  • Robert Y. McMurtry
    • 4
  • John D. Brown
    • 5
  • Geoffrey M. Anderson
    • 6
    • 7
  1. 1.Department of Public Health and Primary CareUniversity of OxfordUK
  2. 2.Unit of Health-Care EpidemiologyUniversity of OxfordUK
  3. 3.Department of Family MedicineUniversity of Western OntarioCanada
  4. 4.Department of SurgeryUniversity of Western OntarioCanada
  5. 5.Department of Clinical Neurological SciencesUniversity of Western OntarioCanada
  6. 6.Department of Health AdministrationUniversity of TorontoTorontoCanada
  7. 7.Institute of Clinical Evaluative SciencesSunnybrook HospitalTorontoCanada

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