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<div id="summaryView" role="tabpanel" aria-labelledby="tabSummaryView">
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Name
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Ambulatory Care Sensitive Conditions
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Short/Other Names
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Not applicable

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Description
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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 Methodology Notes.

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Interpretation
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Low rates are desirable.
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HSP Framework Dimension
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Health System Outputs: Appropriate and effective

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Areas of Need
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Living With Illness, Disability or Reduced Function

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Geographic Coverage
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All provinces/territories

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Reporting Level/Disaggregation
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National, Province/Territory, Region, Neighbourhood Income Quintile

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Indicator Results
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Accessing Indicator Results on Your Health System: In Depth

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
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Name
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Ambulatory Care Sensitive Conditions
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Short/Other Names
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Not applicable

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<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>
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Description
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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 Methodology Notes.

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Calculation: Description
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(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)
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Calculation: Geographic Assignment
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Place of residence

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Calculation: Type of Measurement
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Rate - per 100,000

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Calculation: Adjustment Applied
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Age-adjusted

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Calculation: Method of Adjustment
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Direct Standardization
Standard Population:
Canada 2011

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Denominator
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Description:
Total mid-year population younger than age 75

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Numerator
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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.54.^^, 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.54.GQ-AZ, 1.IJ.55.^^, 1.IJ.57.^^, 1.IJ.76.^^, 1.IJ.80.^^, 1.IJ.86.^^, 1.IK.50.^^, 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-FS, 1.YY.54.LA-NM

Note: Code may be coded in any position. Procedures coded as abandoned after onset (Intervention Status Attribute = A) are excluded.

2. Age at admission younger than 75

3. Sex recorded as male or female

Exclusions:
1. Records with discharge as death (Discharge Disposition Code = 07)

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

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<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>
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Rationale
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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.

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Interpretation
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Low rates are desirable.

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HSP Framework Dimension
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Health System Outputs: Appropriate and effective

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Areas of Need
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Living With Illness, Disability or Reduced Function

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

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References
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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.

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<div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
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Data Sources
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DAD, Demography division, Statistics Canada, HMDB

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Available Data Years
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Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2015

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Geographic Coverage
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All provinces/territories

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Reporting Level/Disaggregation
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National, Province/Territory, Region, Neighbourhood Income Quintile

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<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
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Update Frequency
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Every year

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Indicator Results
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Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

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Updates
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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.

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<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
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Caveats and Limitations
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Not applicable

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Trending Issues
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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.

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Comments
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Indicator results are also available in

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