Comparative research aspects on hospitalizations for ambulatory care sensitive conditions: the case of Brazil and Portugal

Abstract

Hospitalizations for ambulatory care sensitive conditions have been used to measure access, quality and performance of the primary health care delivery system, as timely and adequate care could potentially avoid the need of hospitalization. Comparative research provides the opportunity for cross-country learning process. Brazil and Portugal have reformed their primary health care services in the last years, with similar organizational characteristics. We used hospitalization data of Brazil and Portugal for the year 2015 to compare hospitalizations for ambulatory care sensitive conditions between the two countries, and discussed conceptual and methodological aspects to be taken into consideration in the comparative approach. Brazil and Portugal presented similarities in causes and standardized rates of hospitalizations for ambulatory care sensitive conditions. There was great sensitivity on rates according to the methodology employed to define conditions. Hospitalizations for ambulatory care sensitive conditions are important sources of pressure for both Brazil and Portugal, and there are conceptual and methodological aspects that are critical to render the country-comparison approach useful.

Comparison and Impact of Four Different Methodologies for Identification of Ambulatory Care Sensitive Conditions

“…To illustrate, the CIHI method only considers a few chronic conditions as ACSCs. Furthermore, in this method, individuals aged over 75 years old are excluded, and it is known that age is an important factor associated with hospitalization for ACSCs, as chronic conditions are more prevalent in older populations [25], which might explain the lower rates of ACSCs obtained by this list in comparison with the other methodologies. Additionally, it also suggests that the prevalence of chronic conditions associated with avoidable hospitalizations that are included in the CIHI list is stable across the years under study.…”

“…Since in Portugal, the discharges were coded in ICD-9-CM until 2016, we excluded all the ACSC lists defined with ICD-10 codes. Only the list proposed by Sarmento et al (2020), which is defined in terms of the ICD-10, was converted into ICD-9-CM codes in order to be included in this study, as it was developed for the Portuguese context. The conversion was carried using the General Equivalence Mappings (GEMs) method, implemented in the R package "touch".…”

“…The conversion was carried using the General Equivalence Mappings (GEMs) method, implemented in the R package "touch". Hence, avoidable hospitalizations were identified as ACSCs according to the set of ICD-9-CM codes defined in the lists adopted by the Agency for Healthcare Research and Quality (AHRQ) version 6.0 [13], by the Canadian Institute for Health Information (CIHI) [12], and by the Victorian Ambulatory Care Sensitive Conditions Study (2001-02) [29] and the list of ACSC conditions suggested by Sarmento et al (2020), which was published very recently [30].…”

“…The rate of ACSCs in a specific population is impacted by the list applied in the study, that is, (1) the respective coding of diseases, (2) the version of International Classification of Diseases (ICD), (3) the age group covered, (4) the exclusion criteria, and (5) research setting. Therefore, it varies between contexts [25], causing variability in the results and consequently in their interpretation. At the moment, despite the large number of ACSC lists, many countries do not have a list adapted to their specific context; in general, the choice of the list used to calculate the rates of avoidable hospitalizations is selected according to the choice of the study group.…”

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

“…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.…”