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Indicator Metadata

NameAmbulatory Care Sensitive Conditions
Short/Other Names

Not applicable

Description

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

For further details, please see the General Methodological Notes document.

InterpretationLow rates are desirable.
HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Living With Illness, Disability or Reduced Function

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Neighbourhood Income Quintile

Latest Result Update Date

2014-09

Indicator Results

http://indicatorlibrary.cihi.ca/download/attachments/1114124/AccessingIndicatorResultsonYourHealthSystemv4_EN.pdf?version=1&modificationDate=1409838269216&api=v2

Identifying Information
NameAmbulatory Care Sensitive Conditions
Short/Other Names

Not applicable

Indicator Description and Calculation
Description

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

For further details, please see the General Methodological Notes document.

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)
Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Rate - per 100,000

Calculation: Adjustment Applied

Age-adjusted

Calculation: Method of Adjustment

Direct Standardization
Standard Population:
Canada 1991

Denominator

Description:
Total mid-year population younger than age 75
Exclusions:
Population age 75 and older

Numerator

Description:
Total number of acute care hospitalizations for ambulatory care sensitive conditions in patients younger than age 75
Inclusions:
1. Hospitalization for an ambulatory care sensitive condition is identified as any most responsible diagnosis code of

–Grand mal status and other epileptic convulsions
ICD-9/9-CM: 345
ICD-10-CA: G40, G41

–Chronic obstructive pulmonary disease (COPD)

a. Any most responsible diagnosis (MRDx) code of
ICD-9/9-CM: 491, 492, 494, 496
ICD-10-CA: J41, J42, J43, J44, J47

b. MRDx of acute lower respiratory infection, only when a secondary diagnosis* of J44 in
ICD-10-CA or 496 in ICD-9/9-CM is also present
ICD-9/9-CM: 466, 480–486, 487.0
ICD-10-CA: J10.0, J11.0, J12–J16, J18, J20, J21, J22

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

–Asthma
ICD-9/9-CM: 493
ICD-10-CA: J45

–Diabetes
ICD-9: 250.0, 250.1, 250.2, 250.7
ICD-9-CM: 250.0, 250.1, 250.2, 250.8
ICD-10-CA: E10.0, E10.1, E10.63, E10.64, E10.9
E11.0, E11.1, E11.63, E11.64, E11.9
E13.0, E13.1, E13.63, E13.64, E13.9
E14.0, E14.1, E14.63, E14.64, E14.9

–Heart failure and pulmonary edema
ICD-9/9-CM: 428, 518.4
ICD-10-CA: I50, J81

–Hypertension
ICD-9/9-CM: 401.0, 401.9, 402.0, 402.1, 402.9
ICD-10-CA: I10.0, I10.1, I11

–Angina
ICD-9: 411, 413
ICD-9-CM: 411.1, 411.8, 413
ICD-10-CA: I20, I23.82, I24.0, I24.8, I24.9

† Excluding cases with cardiac procedures.

List of cardiac procedure codes for exclusion:
CCP: 47^^, 480^–483^, 489.1, 489.9, 492^–495^, 497^, 498^
ICD-9-CM: 336, 35^^, 36^^, 373^, 375^, 377^, 378^, 379.4–379.8
CCI: 1.HA.58, 1.HA.80, 1.HA.87, 1.HB.53, 1.HB.54, 1.HB.55, 1.HB.87, 1.HD.53, 1.HD.54, 1.HD.55, 1.HH.59, 1.HH.71, 1.HJ.76, 1.HJ.82, 1.HM.57, 1.HM.78, 1.HM.80, 1.HN.71, 1.HN.80, 1.HN.87, 1.HP.76, 1.HP.78, 1.HP.80, 1.HP.82, 1.HP.83, 1.HP.87, 1.HR.71, 1.HR.80, 1.HR.84, 1.HR.87, 1.HS.80, 1.HS.90, 1.HT.80, 1.HT.89, 1.HT.90, 1.HU.80, 1.HU.90, 1.HV.80, 1.HV.90, 1.HW.78, 1.HW.79, 1.HX.71, 1.HX.78, 1.HX.79, 1.HX.80, 1.HX.83, 1.HX.86, 1.HX.87, 1.HY.85, 1.HZ.53 rubric (except 1.HZ.53.LA-KP), 1.HZ.55 rubric (except 1.HZ.55.LA-KP), 1.HZ.56, 1.HZ.57, 1.HZ.59, 1.HZ.80, 1.HZ.85, 1.HZ.87, 1.IF.83, 1.IJ.50, 1.IJ.55, 1.IJ.57, 1.IJ.76, 1.IJ.80, 1.IJ.86, 1.IK.57, 1.IK.80, 1.IK.87, 1.IN.84, 1.LA.84, 1.LC.84, 1.LD.84, 1.YY.54.LA-NJ

‡ 1.YY.54.LA-NJ was retired as of CCI version 2012 and was included when calculating indicator results prior to 2012–2013.

Note: Code may be coded in any position. Procedures coded as cancelled or abandoned after onset are excluded.

2. Age at admission younger than 75

3. Sex recorded as male or female

4. Canadian resident (Canadian postal code)
Exclusions:
1. Records with discharge as death (Discharge Disposition Code = 06)

2. Newborn, stillbirth or cadaveric donor records (Admission Category = N, R or S)

Background, Interpretation and Benchmarks
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.

Interpretation

Low rates are desirable.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

The appropriate level of hospitalization for these conditions is not known, and large regional variations in the rate of hospitalization for these conditions exist.

References

Anderson GM. Common Conditions Considered Sensitive to Ambulatory Care. In Patterns of Health Care in Ontario, 2nd Ed. Eds. V. Goel et al. Ottawa, ON: CMA; 1996: 104-110.

Billings J, Anderson GM, Newman LS. Recent Findings on Preventable Hospitalizations. Health Aff (Millwood) 1996(15): 239-249.

Billings J, Zeitel L, Lukomnik J,et al. Impact of Socio-Economic Status on Hospital Use in New York City. Health Aff (Millwood) 1993(12): 162-173.

Manitoba Centre for Health Policy and Evaluation. Concept: Ambulatory Care Sensitive (ACS) Conditions. http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1023. Published September 26, 2007. Accessed December 14, 2010.

Availability of Data Sources and Results
Data Sources

DAD, Demography division, Statistics Canada, MED-ÉCHO

Available Data Years

Type of Year:
Fiscal
First Available Year:
1997
Last Available Year:
2012

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Neighbourhood Income Quintile

Result Updates
Update Frequency

Every year

Latest Result Update Date

2014-09

Indicator Results

Web Tool:
Your Health System: In Depth
URL: http://indicatorlibrary.cihi.ca/download/attachments/1114124/AccessingIndicatorResultsonYourHealthSystemv4_EN.pdf?version=1&modificationDate=1409838269216&api=v2

Updates

Beginning with the 2006–2007 rate, the definition of the ambulatory care sensitive conditions indicator was refined to better align it as a measure of primary health care. In the revised definition, the diabetes component includes diabetes with short-term complications and diabetes without mention of complication; angina, hypertension and heart failure components exclude records where cardiac procedures were also coded.

Quality Statement
Caveats and Limitations

Not applicable

Trending Issues

Beginning with the 2006–2007 rate, the definition of the ambulatory care sensitive conditions indicator was refined. Rates based on the new definition were calculated for the previous years to allow for comparisons over time.

Comments

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