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  • Measure Summary
  • NQMC:010028
  • May 2015

Ambulatory care sensitive conditions: age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population younger than age 75 years.

Canadian Institute for Health Information (CIHI). Indicator metadata: ambulatory care sensitive conditions. [internet]. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2015 May [accessed 2015 Jul 13].

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Canadian Institute for Health Information (CIHI). Health indicators 2013: definitions, data sources and rationale. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2013 May. 89 p.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Related Population Health Measures: Population Use of Services

Secondary Measure Domain

Population Health Quality Measure: Population Access

Description

This measure is used to assess the age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population under age 75 years.

Calculation Description: (Total number of acute care hospitalizations for ambulatory care sensitive conditions in patients younger than age 75 ÷ total mid-year population younger than age 75) × 100,000 (age-adjusted)

Rationale

Hospitalization for an ambulatory care sensitive condition is considered to be a measure of access to appropriate primary health care. While not all admissions for these conditions are avoidable, it is assumed that appropriate ambulatory care could prevent the onset of this type of illness or condition, control an acute episodic illness or condition, or manage a chronic disease or condition. A disproportionately high rate is presumed to reflect problems in obtaining access to appropriate primary care.

Evidence for Rationale

Anderson GM. Common conditions considered sensitive to ambulatory care. In: Goel V, et al, editor(s). Patterns of health care in Ontario. 2nd ed. Ottawa (ON): CMA; 1996. p. 104-10.

Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. Health Aff (Millwood). 1996 Fall;15(3):239-49. PubMed External Web Site Policy

Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood). 1993 Spring;12(1):162-73. PubMed External Web Site Policy

Canadian Institute for Health Information (CIHI). Indicator metadata: ambulatory care sensitive conditions. [internet]. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2015 May [accessed 2015 Jul 13].

Manitoba Centre for Health Policy and Evaluation. Concept: ambulatory care sensitive (ACS) conditions. [internet]. 2007 Sep 26 [accessed 2010 Dec 14].

Primary Health Components

Ambulatory care sensitive conditions (angina, asthma, chronic obstructive pulmonary disease [COPD], diabetes, grand mal status and other epileptic convulsions, heart failure and pulmonary edema, hypertension); acute care hospitalization

Denominator Description

Total mid-year population younger than age 75 (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Total number of acute care hospitalizations for ambulatory care sensitive conditions in patients younger than age 75 (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Monitoring and planning

Monitoring health state(s)

National health policymaking

National reporting

State/Provincial health policymaking

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Physicians

Public Health Professionals

Least Aggregated Level of Services Delivery Addressed

Regional, County or City

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age less than 75 years

Target Population Gender

Either male or female

Public Health Aims for Quality

Population-centered

Transparency

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

April 1 to March 31

Denominator Sampling Frame

Geographically defined

Denominator (Index) Event or Characteristic

Geographic Location

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Total mid-year population younger than age 75

Exclusions
Population age 75 and older

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Total number of acute care hospitalizations for ambulatory care sensitive conditions in patients younger than age 75

  1. Hospitalization for an ambulatory care sensitive condition is identified as any most responsible diagnosis code of
    • Grand mal status and other epileptic convulsions
    • Chronic obstructive pulmonary diseases (COPD)
      1. Any most responsible diagnosis (MRDx) code
      2. MRDx of acute lower respiratory infection, only when a secondary diagnosis* of J44 in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canadian Enhancement (ICD-10-CA) or 496 in International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9/9-CM) is also present
    • Asthma
    • Diabetes
    • Heart failure and pulmonary edema**
    • Hypertension**
    • Angina**
  2. Age at admission younger than 75
  3. Sex recorded as male or female
  4. Canadian resident (Canadian postal code)

Note:

  • Code may be coded in any position. Procedures coded as cancelled or abandoned after onset are excluded.
  • Refer to the original measure documentation for the administrative codes.

*Secondary diagnosis refers to a diagnosis other than the most responsible one.

**Excluding cases with cardiac procedures. Refer to the original measure documentation for a list of cardiac procedure codes for exclusion.

Exclusions

  1. Records with discharge as death (Discharge Disposition Code = 07)
  2. Newborn, stillbirth or cadaveric donor records (Admission Category = N, R or S)

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

National public health data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

Allowance for Patient or Population Factors

Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

Description of Allowance for Patient or Population Factors

  • Indicators are reported at the national, provincial/territorial, and regional levels.
  • Unless otherwise specified, for indicators based on place of residence, data is reported based on the region of the patient's residence, not region of hospitalization. Consequently, these figures reflect the hospitalization experience of residents of the region wherever they are treated, including out of province, as opposed to the comprehensive activity of the region's hospitals (that will also treat people from outside of the region). Hospitalizations occurring in the U.S. or abroad are not included.
  • For indicators based on place of service (where the patient was treated), data is reported based on the administrative region of the facility (e.g., region of hospitalization).
  • Rates are standardized or risk-adjusted wherever possible to facilitate comparability across provinces/regions/facilities and over time.
  • Standardized rates are adjusted by age (collapsed to five-year groupings) using a direct method of standardization based on the July 1, 1991, Canadian population.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Ambulatory care sensitive conditions.

Measure Collection Name

Health Indicators ePublication 2015

Submitter

Canadian Institute for Health Information

Developer

Canadian Institute for Health Information

Funding Source(s)

Canadian Government

Composition of the Group that Developed the Measure

Employees: Canadian Institute for Health Information (CIHI) Health Indicators

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was adapted from the following source:

  • Ambulatory Care Sensitive Conditions (ACSC) Hospitalization Rates [Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. Health Affairs, 1996.]

Date of Most Current Version in NQMC

2015 May

Measure Maintenance

Annually

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Canadian Institute for Health Information (CIHI). Health indicators 2013: definitions, data sources and rationale. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2013 May. 89 p.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

Canadian Institute for Health Information (CIHI). Indicator metadata: ambulatory care sensitive conditions. [internet]. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2015 May [accessed 2015 Jul 13].

Measure Availability

Source available from the Canadian Institute for Health Information (CIHI) Web site External Web Site Policy.

For more information, contact CIHI at 4110 Yonge Street, Suite 300, Toronto, Ontario, Canada, M2P 2B7; Phone: 416-481-2002; Fax: 416-481-2950; E-mail: hsp@cihi.ca; Web site: www.cihi.ca External Web Site Policy.

Companion Documents

The following are available:

  • Canadian Institute for Health Information (CIHI). Indicator library: general methodology notes - clinical indicators, March 2015. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2015 Mar. 19 p. This document is available from the Canadian Institute for Health Information (CIHI) Web site External Web Site Policy.
  • Canadian Institute for Health Information (CIHI). Canadian coding standards for version 2015 ICD-10-CA and CCI. Ottawa (ON): Canadian Institute for Health Information (CIHI); 2015. 511 p. This document is available from the CIHI Web site External Web Site Policy.
  • Canadian Institute for Health Information (CIHI). Health indicators interactive tool. [internet]. Ottawa (ON): Canadian Institute for Health Information (CIHI); [accessed 2015 Jan 20]. This tool is available from the CIHI Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on October 10, 2008. The information was verified by the measure developer on December 18, 2008.

This NQMC summary was updated by ECRI Institute on April 19, 2010. The information was verified by the measure developer on June 24, 2010.

This NQMC summary was retrofitted into the new template on May 18, 2011.

This NQMC summary was updated by ECRI Institute on March 18, 2013. The information was verified by the measure developer on May 17, 2013.

The CIHI informed NQMC that this measure was updated on October 31, 2013 and provided an updated version of the NQMC summary. This NQMC summary was reviewed and updated accordingly by ECRI Institute on February 21, 2014.

This NQMC summary was updated again by ECRI Institute on September 4, 2015. The information was verified by the measure developer on November 6, 2015.

The information was reaffirmed by the measure developer on April 29, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

Use of Canadian Institute for Health Information's (CIHI) quality measure for research, private study, education, or other non-commercial purposes is permitted where full credit is given to CIHI as author and owner of the quality measure. Any use that is wholly or partly commercial in nature requires CIHI's express written permission.

Questions and inquiries may be directed to: CIHI, Health Indicators, 4110 Yonge Street, Suite 300, Toronto, Ontario, Canada, M2P 2B7; Phone: 416-481-2002; Fax: 416-481-2950.

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