The role of primary care in preventing ambulatory care sensitive conditions

TLDR

Ambulatory Care Sensitive Conditions (ACSC) are used to gauge primary health care effectiveness, but their relationship to PHC has been studied mainly in the US, with limited evidence in Europe. This study aims to create an ACSC list for the European context and identify which primary health care activities most effectively reduce hospitalization rates. The authors applied Solberg and Weissman’s five selection criteria to 113 ICD‑9 codes, used a Delphi panel of 44 experts to review them, and analyzed hospitalization rates from 248,050 discharges in Catalonia to produce the ACSC list. The study identified 61 core ACSC codes and 90 expanded codes, demonstrating that the core list highlights conditions amenable to primary care interventions and that the expanded list can assess overall PHC performance and specialist care responsibility.

Abstract

Background: To examine the postulated relationship between Ambulatory Care Sensitive Conditions (ACSC) and Primary Health Care (PHC) in the US context for the European context, in order to develop an ACSC list as markers of PHC effectiveness and to specify which PHC activities are primarily responsible for reducing hospitalization rates. Methods: To apply the criteria proposed by Solberg and Weissman to obtain a list of codes of ACSC and to consider the PHC intervention according to a panel of experts. Five selection criteria: i) existence of prior studies; ii) hospitalization rate at least 1/10,000 or ‘risky health problem’; iii) clarity in definition and coding; iv) potentially avoidable hospitalization through PHC; v) hospitalization necessary when health problem occurs. Fulfilment of all criteria was required for developing the final ACSC list. A sample of 248,050 discharges corresponding to 2,248,976 inhabitants of Catalonia in 1996 provided hospitalization rate data. A Delphi survey was performed with a group of 44 experts reviewing 113 ICD diagnostic codes (International Classification of Diseases, 9th Revision, Clinical Modification), previously considered to be ACSC. Results: The five criteria selected 61 ICD as a core list of ACSC codes and 90 ICD for an expanded list. Conclusions: A core list of ACSC as markers of PHC effectiveness identifies health conditions amenable to specific aspects of PHC and minimizes the limitations attributable to variations in hospital admission policies. An expanded list should be useful to evaluate global PHC performance and to analyse market responsibility for ACSC by PHC and Specialist Care.