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

Abstract

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.

Exploring Italian healthcare facilities response to COVID-19 pandemic: Lessons learned from the Italian Response to COVID-19 initiative

“…The need to reshape health services delivery by improving primary and community care provision was already suggested in recent publications as a fundamental strategy to face health pandemic challenges and render communities more resilient ( 28 ). Strengthening primary and community care services might contribute to reducing the surge of avoidable hospitalizations for Ambulatory Care Sensitive conditions (ACSCs) that persist in the long term after disasters, as it was shown in a recent literature review ( 29 ). Furthermore, the respondents considered adequate training of HCWs as fundamental to guarantee safety and protection and to face the impact of the pandemic, reflecting findings reported in previous studies ( 30 ).…”

Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection

“…[1][2][3][4] They are also increasingly used as a measure of health system performance during public health emergencies. 5 During the COVID-19 pandemic, health system capacity and pandemic-related restrictions caused disruptions to outpatient care delivery in the US, which may have hindered ACSC treatment and increased potentially preventable hospitalizations. [6][7][8][9][10][11][12] Messaging early in the pandemic encouraging people to stay home when sick, as well as postinfection sequelae, may have compounded these risks among individuals with SARS-CoV-2.…”

“…Thus, hospitalizations for ACSCs (hereinafter referred to as potentially preventable hospitalizations) are widely recognized as an indicator of ambulatory care access and quality . They are also increasingly used as a measure of health system performance during public health emergencies …”

Hospital‐associated disability due to avoidable hospitalizations among older adults

“…ACSCs may be acute conditions (e.g., pneumonia, urinary tract infections) or exacerbations of chronic conditions (e.g., congestive heart failure, chronic obstructive pulmonary disease), 12 and are gaining increased attention in acute care as a measure of healthcare quality and accessibility. 13 Although originally conceptualized as a measure of healthcare access in younger disadvantaged populations, 14 ACSCs are particularly relevant to the older adult population, who experience the highest rate of hospitalizations 15 and hospitalizations for ACSCs. 16 By identifying ACSCs, hospitalizations could be avoided with early intervention in the primary care setting, thus potentially decreasing the incidence of HAD and subsequent loss of independence.…”

“…ACSCs encompass both conditions where acute decline can be avoided entirely with better preventive care, and conditions where early stages of acute decline can be managed on an outpatient basis to avoid hospitalization. ACSCs may be acute conditions (e.g., pneumonia, urinary tract infections) or exacerbations of chronic conditions (e.g., congestive heart failure, chronic obstructive pulmonary disease), 12 and are gaining increased attention in acute care as a measure of healthcare quality and accessibility 13 . Although originally conceptualized as a measure of healthcare access in younger disadvantaged populations, 14 ACSCs are particularly relevant to the older adult population, who experience the highest rate of hospitalizations 15 and hospitalizations for ACSCs 16 .…”