Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC): The factors that matter

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by Claudia Sanmartin, Saeeda Khan, and the Longitudinal Health and Administrative Data Research Team

Hospitalizations related to ambulatory care sensitive conditions (ACSC) represent an indirect measure of access to primary care and the capacity of the system to manage chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD) and asthma.  ACSC-related hospitalizations are commonly referred to as avoidable hospitalizations and thus a measure of the performance of the primary care system.  There is limited evidence linking the availability of primary care and ACSC-related hospitalizations.  There is, however, growing evidence regarding the role of patient characteristics, such as socioeconomic status, that may place individuals at higher risk for such a hospitalization. 

This study represents the first national level assessment of a broad range of factors associated with ACSC-related hospitalizations.  The unique feature of this study is the focus on those individuals most at risk – that is, those with at least one ACS condition.  The study is based on the linked health survey and hospital data that provide comprehensive information regarding patient characteristics, their access to primary care and whether or not they experienced an ACSC related hospitalization.  Understanding the role of these factors may shed light on how primary care services may reduce the risk of these "avoidable" hospital admissions.

Key Findings

• Overall, individuals who experience an ACSC related hospitalization represent only 0.4% of Canadians under the age of 75, but represent 6% of all hospitalized individuals and use nearly 11% of all hospital days.  
• Over half of those with an ACSC-related hospitalization were aged 60 or older, compared with less than half among those hospitalized for other reasons, and one in four among those not admitted to hospital. 
• Results of age/sex adjusted descriptive statistics indicate that those who had an ACSC-related hospitalization…
  • reported poorer health across several measures and were more likely to have comorbidities;
  • were more likely to be in the lowest household income quintile;
  • were more likely to be daily or former smokers.
• Contrary to expectations, individuals who had an ACSC related hospitalizations were also more likely to be users of primary and specialist care services and more likely to have a regular medical doctor.
• Results of multivariate analyses in which all relevant factors are considered simultaneously indicated that older age (60+years), poor health status, smoking and having an at least one hospitalizations in the previous year increased the odds experiencing an ACSC related admissions for both men and women.  Low income and being separated and divorced increased the odds of an ACSC-related admission for men; being underweight significantly increased the odds for women. 
• Finally, the report also provides "risk profiles" that highlight the characteristics of individuals at low and high risk of an ACSC-related hospitalization.