Analyzing admission rates for multiple ambulatory care–sensitive conditions

Leventer‐Roberts, Maya; Cohen-Stavi, Chandra; Hoshen, Moshe; Gofer, Ilan; Sherf, Michael; Balicer, Ran D.

doi:10.37765/ajmc.2020.43158

Cited by 6 publications

(4 citation statements)

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“…Prior investigations into ACSCs have been limited to medical patients, making this the first assessment of ACSC admissions in the postoperative setting, to our knowledge. [21][22][23][24][25] Studies investigating the causes of readmission and attempts to predict those at highest risk have not specifically addressed causes that may be potentially preventable but have investigated all causes of readmission or those for surgical complications, potentially missing an opportunity to target readmission interventions to those that might be most likely to be prevented. [26][27][28] Criticisms against using readmissions as a quality measure in a postsurgical population compared with the medical population, in which they are much more widely accepted, have been centered around the fact that medical readmissions are more commonly associated with suboptimal transition of care from the hospital to the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

“…This finding suggests that undergoing surgery increases the risk of hospital admission due to these underlying medical problems rather than only surgery-specific reasons. Prior investigations into ACSCs have been limited to medical patients, making this the first assessment of ACSC admissions in the postoperative setting, to our knowledge . Studies investigating the causes of readmission and attempts to predict those at highest risk have not specifically addressed causes that may be potentially preventable but have investigated all causes of readmission or those for surgical complications, potentially missing an opportunity to target readmission interventions to those that might be most likely to be prevented …”

Section: Discussionmentioning

confidence: 99%

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Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities

et al. 2021

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IMPORTANCE Rehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable.OBJECTIVE To evaluate the degree to which readmissions after major surgery are potentially preventable. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used a weighted sample of 1 937 354 patients from the 2017 National Readmissions Database to evaluate all adult inpatient hospitalizations for 1 of 7 common major surgical procedures. Statistical analysis was performed from January 14 to November 30, 2020. MAIN OUTCOMES AND MEASURESThe study calculated 90-day readmission rates as well as rates of readmissions that were considered potentially preventable. Potentially preventable readmissions (PPRs) were defined as those with a primary diagnosis code for superficial surgical site infection, acute kidney injury, aspiration pneumonitis, or any of the Agency for Healthcare Research and Quality-defined ambulatory care sensitive conditions. Multivariable logistic regression was used to identify factors associated with PPRs. RESULTSA total weighted sample of 1 937 354 patients (1 048 046 women [54.1%]; mean age, 66.1 years [95% CI, 66.0-66.3 years]) underwent surgical procedures; 164 755 (8.5%) experienced a readmission within 90 days. Potentially preventable readmissions accounted for 29 321 (17.8%) of all 90-day readmissions, for an estimated total cost to the US health care system of approximately $296million. The most common reasons for PPRs were congestive heart failure exacerbation (34.6%), pneumonia (12.0%), and acute kidney injury (22.5%). In a multivariable model of adults aged 18 to 64 years, patients with public health insurance (Medicare or Medicaid) had more than twice the odds of PPR compared with those with private insurance (adjusted odds ratio, 2.09; 95% CI, 1.94-2.25).Among patients aged 65 years or older, patients with private insured had 18% lower odds of PPR compared with patients with Medicare as the primary payer (adjusted odds ratio, 0.82; 95% CI, 0.74-0.90). CONCLUSIONS AND RELEVANCEThis study suggests that nearly 1 in 5 readmissions after surgery are potentially preventable and account for nearly $300 million in costs. In addition to better inpatient care, improved access to ambulatory care may represent an opportunity to reduce costly readmissions among surgical patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities

et al. 2021

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“…The literature on ACSCs has been growing over the past ten years. Besides methodological publications aimed at defining country-specific lists of ACSCs [ 12 ] and those unraveling methodological implications and potential pitfalls deriving from the use of ACSCs [ 13 ], the published original studies have primarily aimed at comparing hospitalization rates due to ACSCs across different groups or countries [ 14 , 15 , 16 ], performing economic evaluations of avoidable hospitalizations [ 17 , 18 ], identifying inequalities in terms of access to ambulatory care [ 19 , 20 ], and examining trends over the years to spot temporal increases and geographic variations [ 21 , 22 ]. Despite the vast body of literature using ACSC hospitalizations as an indicator of PHC performance and functioning, the literature examining ACSC hospitalizations during disasters and public health emergencies is scarce.…”

Section: Introductionmentioning

confidence: 99%

Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters: A Systematic Review

Lamberti-Castronuovo

Valente

Aleni

et al. 2022

IJERPH

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Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well-established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes. We conducted a systematic review to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers. A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered. The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.

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“…Hospitalizations due to worsening of the clinical course of ambulatory care sensitive conditions (ACSC) are the significant and growing burden on health systems [1]. Chronic heart failure (CHF) is one of the five leaders among chronic ACSC both in the frequency of hospitalizations and in their cost [2].…”

Section: Introductionmentioning

confidence: 99%

Medication Adherence and Decreased Kidney Function as Predictors of Hospitalization for Chronic Heart Failure in Elderly Patients

Ханюков¹,

Smolianova²

2021

Scientific and practical journal

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Hospitalizations due to worsening of the clinical course of ambulatory care sensitive conditions (ACSC) are the significant and growing burden on health systems. Chronic heart failure (CHF) is one of the five leaders among chronic ACSC both in the frequency of hospitalizations and in their cost. Therefore, it is important to find predictors of the clinical course worsening which are easy to use in ambulatory settings. The aim of the research: to assess the effect of medication adherence and decreased renal function on the probability of hospitalization for CHF in the elderly during 6 months. Materials and methods. The prospective research included 111 ambulatory elderly patients aged from 60 to 74 years with CHF, stage II, arterial hypertension, stage II and chronic kidney disease, stage II-IIIA. During the first ambulatory visit a general clinical examination and ambulatory card analysis were performed. Creatinine level was checked with calculation of the glomerular filtration rate according to the formula of the Chronic Kidney Disease Epidemiology Collaboration (GFR EPI) to assess renal function. In addition, a 6-minute walk test (6MWT) was performed and a quality of life assessment was conducted according to Minnesota Living with Heart Failure Questionnaire. Adherence assessment on a Morisky Green Medication Adherence Scale as well as a collection of the information about hospitalization during the previous 6 months was done during the last visit. The variable "interaction" between decreased renal function and poor medication adherence was introduced separately into the logistic analysis. A logistic regression analysis was used to assess the influence of factors on the probability of hospitalization for CHF. Results. During the observation 21 patients were hospitalized for CHF (21/93, 23%). The analysis of the distribution of adherence level and GFR EPI ≤ 59,9 mL/min/1,73 m2 between groups of hospitalized and non-hospitalized patients revealed a predominance of non-adherent patients, as well as those with decreased renal function, in the group of hospitalized ones. Clinical characteristics and laboratory parameters, by which the differences were found between hospitalized and non-hospitalized patients, as well as categorical variables received by ROC-analysis - quality of life, GFR EPIcat, systolic blood pressure, 6MWTcat, and variable "interaction", were included in the univariate logistic analysis. According to univariate logistic analysis, the hospitalization probability increased with GFR EPI ≤ 59,9 mL/min/1,73 m2 (OR-6,73, CI 2,34-19,35) and decreased in the presence of medication adherence (OR-0,08, CI 0,02-0,37). In multivariate analysis (adjustment for lung crackles and functional class according to NYHA) or were 4,95 (CI 1,18-20,78) for GFR EPI ≤ 59,9 mL/min/1,73 m2 and 0,11 (CI 0,02-0,81) for medication adherence. During assessing the "interaction" variable it was found that in non-adherent patients with GFR EPI≤59,9 ml/min/1,73m2 the chance of inpatient treatment for CHF significantly increased by 6.82 times on average, with a maximum increase by 20 times. Conclusions. Medication adherence and decreased renal function in our research were shown to be significant predictors of hospitalization for CHF, which are simple to measure and assess and can be used in an outpatient setting. By increasing adherence level, especially in elderly patients with impaired renal function, it is possible to reduce the chance of inpatient treatment caused by CHF by 9.1 times.

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Analyzing admission rates for multiple ambulatory care–sensitive conditions

Cited by 6 publications

References 0 publications

Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities

Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities

Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters: A Systematic Review

Medication Adherence and Decreased Kidney Function as Predictors of Hospitalization for Chronic Heart Failure in Elderly Patients

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