Hospitalization for Ambulatory Care-Sensitive Conditions: A Method for Comparative Access and Quality Studies Using Routinely Collected Statistics

Abstract

Access to health care may be defined as the ability to obtain and benefit from care. Universal access to necessary care remains one of the chief goals of the health-care system in Canada. 1 Ambulatory caresensitive conditions (ACSC) are a new negative indicator of access. The rate of hospitalization for ACSC is higher in communities with poor access to ambulatory care. This paper describes the development, using consensus panels, of a Canadian set of ACSC and compares them to similar categories of care developed elsewhere. 2-4 METHODS Questionnaire development We identified nearly 400 4-digit International Classification of Diseases 9 th Revision (ICD-9) diagnosis codes and over 150 3-digit Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures (CCP) procedure codes with a potential relationship to health care access in English and French language articles, abstracts, and other source materials between 1972 to 1997 using the Medline, science citation, CINAHL, and Healthstar electronic databases, and manual searches of several clinical and public health journals. We excluded rare diagnoses and procedures (incidence of hospitalization <0.25/100,000 population in Ontario, 1992) from further consideration. We organized remaining potential ACSC into 33 diagnostic and 18 procedural groupings based on etiology, typical severity on admission to hospital, and common treatments. We entered these groupings into modified versions of questionnaires used by Billings et al. 3 The questionnaire asked respondents to rate: the effect of a patient's health behaviours, physical and social environment, and access to ambulatory and inpatient care on the relative risk of hospitalization for each clinical grouping. The questionnaire also asked respondents to rate the extent of geographic variation in the incidence of the condition(s) underlying each grouping and in the degree of professional consensus over the clinical indications for admission. (Copies available from ADB.) Consensus panel processes We recruited by telephone 13 senior hospital and community-based physicians and surgeons practicing in a large urban centre to participate on a Delphi panel. Each panelist received an initial mailing with a description of the study, the questionnaire, and a stamped, addressed return envelope. Following the return of the questionnaire, we calculated the mean response

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