Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition
Abstract
With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. ACSC are promising healthcare quality indicators widely used internationally, potentially creating opportunity for health care system quality improvement. The overall aim of this thesis was to explore, assess and evaluate ACSC hospitalization as a healthcare quality indicator for one condition, uncomplicated hypertension.
We conducted three studies to achieve the aim. Our first study explored ACSC hospitalization rates for uncomplicated hypertension, taking into account important patient characteristics among hypertensive patients. Using population-based data in four provinces we found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, potentially indicating improvement in community care. We found geographic variations in the rate of hospitalizations, potentially signifying disparity among the provinces and those residing in rural versus urban regions. Our second study examined the association between ACSC hospitalizations for uncomplicated hypertension and previous primary care physician (PCP) utilization. Among this population-based cohort of hypertensive patients we found as the frequency of hypertension-related PCP visits increased the adjusted rate of ACSC hospitalizations also increased, even when stratified by demographic and clinical variables. This suggests that hospitalization for uncomplicated hypertension is not reduced with increasing frequency of PCP visits and may not be an appropriate indicator to measure and evaluate patients’ access to primary care. Our final study tested inter-physician reliability of judgments of avoidable hospitalizations for uncomplicated hypertension derived from medical chart review. We found a low proportion of ACSC hospitalizations were rated as avoidable, with poor agreement between physician raters. These findings point either to a need to abandon the use of the ACSC entirely; or alternatively a need to develop explicit criteria for judging avoidability.
This research has provided crucial information for the interpretation of ACSC findings for uncomplicated hypertension. The results indicate that the use of this health quality indicator is questionable and may not provide information that is applicable for interventions to improve quality of primary care. At present, ACSC are most appropriately used as a starting point for assessing potential issues in the community which would then require further, more in-depth analysis.
Description
Keywords
Epidemiology, Health Care Management
Citation
Walker, R. (2015). Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26381