No abstract

As the health care system evolves towards increased levels of managed care, planners and managers will need to understand how the utilization of ambulatory care services influences the use of more expensive hospital care. Preventable hospitalization, an index based on Ambulatory Care Sensitive (ACS) conditions, is proposed as an indicator for identifying communities with significant ambulatory care needs. The design and marketing of ambulatory health care services functionally adapted to meet the challenges of managed care will require new forms of health care information to plan, market, monitor, and evaluate the outcomes of health care policies and programs. An example is presented of the use of preventable hospitalizations as indicators of ambulatory care needs in 48 communities in Massachusetts.

N INFANT weighing 1530 g and born at 31 weeks' gestation by emergency cesarean delivery was intubated in the delivery room because of respiratory distress. Endotracheal surfactant was administered, and she was transferred to the neonatal intensive care unit. Within an hour, high-frequency oscillation ventilation was started because of difficulty maintaining oxygenation with conventional ventilation. A double-lumen 3F catheter was inserted into an umbilical vein. The baby's clinical condition improved rapidly over the next 2 days, and she was extubated and maintained on continuous positive airway pressure. At age 4 days, she was breathing room air spontaneously.