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<tr><td>Name</td><td>

Ambulatory Care Sensitive Conditions

</td></tr>

<tr><td>Short/Other Names</td><td>

Not applicable

</td></tr>


<tr><td>Description</td><td>

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).

</td></tr>

<tr><td>Interpretation</td><td>

Low rates are desirable.

</td></tr>

<tr><td>HSP Framework Dimension</td><td>

Health System Outputs: Appropriate and effective

</td></tr>

<tr><td>Areas of Need</td><td>

Living With Illness, Disability or Reduced Function

</td></tr>

<tr><td>Geographic Coverage</td><td>

All provinces/territories

</td></tr>


<tr><td>Reporting Level/Disaggregation</td><td>

National, Province/Territory, Region, Neighbourhood Income Quintile

</td></tr>



<tr><td>Indicator Results</td><td>

Accessing Indicator Results on Your Health System: In Depth

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>

<table id="identifyingInfoRegion">

<tr><td>Name</td><td>

Ambulatory Care Sensitive Conditions

</td></tr>

<tr><td>Short/Other Names</td><td>

Not applicable

</td></tr>
</table>



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

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id

="descAndCalRegion">

<tr><td>Description</td><td>

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).

</td></tr>

<tr><td>Calculation: Description</td><td>

(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)

</td></tr>

<tr><td>Calculation: Geographic Assignment</td><td>

Place of residence

</td></tr>

<tr><td>Calculation: Type of Measurement</td><td>

Rate - per 100,000

</td></tr>

<tr><td>Calculation:  Adjustment Applied</td><td>

Age-adjusted

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<tr><td>Calculation:  Method of Adjustment</td><td>

Direct Standardization
Standard Population:
Canada 2011

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<tr><td>Denominator</td><td>

Description:
Total mid-year population younger than age 75

</td></tr>

<tr><td>Numerator</td><td>

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

   ...

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

   ...

   1. 1. Chronic obstructive pulmonary disease (COPD)

      ...

      1. 1. 1. Any most responsible diagnosis (MRDx) code of
               ICD-9/9-CM: 491, 492, 494, 496
               ICD-10-CA: J41, J42, J43, J44, J47

      ...

      1. 1. 1. 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.

      ...

      1. 1. Asthma
            ICD-9/9-CM: 493
            ICD-10-CA: J45

      ...

      1. 1. 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

      ...

      1. 1. Heart failure and pulmonary edema^†
            ICD-9/9-CM: 428, 518.4
            ICD-10-CA: I50, J81

      ...

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

      ...

      1. 1. 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

      ...

      1. 1. 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.

      ...

      2. Admission to an acute care institution (Facility Type Code = 1)
      3. Age at admission younger than 75

      ...

      1. Sex recorded as male or female

      Exclusions:

      ...

      1. Records with discharge as death (Discharge Disposition Code = 07, 72*, 73*, 74*)

      ...

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

      
      Note
      *2018–2019 data onward.

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

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      <tr><td>Rationale</td><td>
      

      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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      Table Cell (td)
      Interpretation

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      <tr><td>Interpretation</td><td>
      

      Low rates are desirable.

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      HSP Framework Dimension

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      <tr><td>HSP Framework Dimension</td><td>
      

      Health System Outputs: Appropriate and effective

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      Table Cell (td)
      Areas of Need

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      <tr><td>Areas of Need</td><td>
      

      Living With Illness, Disability or Reduced Function

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      Targets/Benchmarks

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      <tr><td>Targets/Benchmarks</td><td>
      

      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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      Table Cell (td)
      References

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      </td></tr>
      
      
      <tr><td>References</td><td>
      

      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^{Image Added}. Published September 26, 2007. Accessed December 14, 2010.

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      </td></tr> </table> <div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
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      id availabilityRegion
      Table Row (tr) Table Cell (td) Data Sources Table Cell (td) DAD, Demography division, Statistics Canada, HMDB
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      Table Cell (td)
      Available Data Years

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      <tr><td>Data Sources</td><td>
      

      DAD, HMDB

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      </td></tr> <tr><td>Available Data Years</td><td>

      Type of Year:
      Fiscal
      First Available Year:
      2010
      Last Available Year:
      

      ...

      2019

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      Geographic Coverage

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      <tr><td>Geographic Coverage</td><td>
      

      All provinces/territories

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      Table Cell (td)
      Reporting Level/Disaggregation

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      </td></tr>
      
      
      <tr><td>Reporting Level/Disaggregation</td><td>
      

      National, Province/Territory, Region, Neighbourhood Income Quintile

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      </td></tr> </table> <div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
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      id resultRegion
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      Update Frequency

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      <tr><td>Update Frequency</td><td>
      

      Every year

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      Table Cell (td)
      Indicator Results

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      <tr><td>Indicator Results</td><td>
      

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

      Table Row (tr)

      Table Cell (td) Updates Table Cell (td) 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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      <tr><td>Updates</td><td>
      

      Not applicable

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      </td></tr> </table> <div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div> <table
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      Caveats and Limitations

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      <tr><td>Caveats and Limitations</td><td>
      

      Not applicable

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      Table Cell (td) Trending Issues Table Cell (td) 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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      Table Cell (td)
      Comments

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      <tr><td>Trending Issues</td><td>
      

      Not applicable

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      </td></tr> <tr><td>Comments</td><td>

      Indicator results are also available in

      • The Health Indicators e-publication (http://yourhealthsystem.cihi.ca/epub/?language=en^{Image Added}), updated annually starting from data year

      ...

      • 2001-2002

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