Hospitalizations for ambulatory care sensitive conditions in the Region of Murcia

Introduction: Ambulatory care sensitive conditions (ACSC) are a set of selected codes of hospital discharge diagnosis that identify hospitalizations considered to be avoidable through the application interventions usually delivered in primary care (PC). Objective: To study the magnitude of avoidable hospitalizations in the region of Murcia (RM) and to assess the usefulness of the "ACSC rate" indicator to test the effectiveness of PC. Material and method: The minimum basic data sets (MBDS) for 2002 and 2003 of nine public hospitals in the RM, the 2003 census, and the short-list of ACSC codes were used. The number and percentage of hospital admissions, hospital stays, and deaths from ACSC were determined. Crude and standardized rates were calculated. Results: Over the 2-year period analyzed, there were 19,108 admissions, 159,180 hospital stays and 1,396 deaths due to ACSC, representing 10.1%, 12.1% and 21.2% of the total number of admissions, stays, and deaths. The crude rate was 75.27% per 10,000 residents. The main cause of ACSC was hypertensive heart disease, followed by heart failure and pneumonia. One of the primary care areas showed a standardized rate ratio of 1.08 (95% confidence interval of 1.03-1.12) compared with the lowest. At the hospital level, the percentage of episodes of ACSC fluctuated between 14.2% and 7.5%. By department the highest percentage of ACSC was found in internal medicine, cardiology and general surgery. Seven diagnosis-related groups accounted for more than 50% of episodes. Conclusions: There is a wide margin for improvement of the effectiveness of PC in RM, especially in hypertensive heart disease, heart failure, and pneumonia. Before attributing the results to PC, other factors should be ruled out. Differences in the quality of the MBDS may also affect the results.