Methodology
Name
Ambulatory 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 Methodology Notes (PDF).
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.
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
- Neighbourhood Income Quintile
Indicator Results
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
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)
Type of Measurement
Rate - per 100,000
Denominator
Description:
Total mid-year population younger than age 75
Numerator
Description:
Total number of acute care hospitalizations for ambulatory care sensitive conditions in patients younger than age 75
Inclusions:
- 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 lower respiratory diseases (except asthma)
- Any most responsible diagnosis (MRDx) code of
ICD-9/9-CM: 491, 492, 494, 496
ICD-10-CA: J41, J42, J43, J44, J47 - 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.
- Any most responsible diagnosis (MRDx) code of
- 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: J81 (MRDx), I50 (MRDx), I50 as diagnosis type (1) when I11 is MRDx - Hypertension†
ICD-9/9-CM: 401.0, 401.9, 402.0, 402.1, 402.9
ICD-10-CA: I10 (MRDx), I11 as MRDx when I50 as diagnosis type (1) is not present - 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, 1.YY.54.LA-FR, 1.YY.54.LA-FU
Note:
Code may be coded in any position. Procedures coded as abandoned after onset (Intervention Status Attribute = A) are excluded.
- Grand mal status and other epileptic convulsions
- Admission to an acute care institution (Facility Type Code = 1)
- Age at admission younger than 75
- Sex recorded as male or female
Exclusions:
- Records with discharge as death (Discharge Disposition Code = 07, 72*, 73*, 74*)
- Newborn, stillbirth or cadaveric donor records (Admission Category Code = N, R or S)
Note *
2018–2019 data onward.
Method of Adjustment
Direct standardization
Standard Population:
Canada 2011
Adjustment Applied
Age-adjusted
Geographic Assignment
Place of residence
Data Sources
- DAD
- HMDB
Caveats and Limitations
Not applicable
Trending Issues
Not applicable
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.
Comments
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