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Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study.

ABSTRACT: OBJECTIVES:The rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there was an association between the rate of admissions for ACSCs and PX. DESIGN:Multicentred, prospective, cohort study SETTING: This study was conducted on five rural islands in Okinawa, Japan. PARTICIPANTS:The study participants were all island inhabitants aged 65 years or older. PRIMARY OUTCOME MEASURES:This study examined the association between ACSCs and PX assessed by a questionnaire, the Japanese Version of Primary Care Assessment Tool. ACSCs were classified using the International Classification of Diseases, Tenth Revision, and the rate of admissions for ACSCs in 1?year. RESULTS:Of 1258 residents, 740 completed the questionnaire. This study documented 38 admissions for ACSCs (29 patients, males/females: 15/14, median age 81.9) that included congestive heart failure (11), pneumonia (7) and influenza (5). After adjusting for covariates and geographical clustering, admissions for ACSCs had a significant positive association with each patient's PX scores (OR per 1 SD increase=1.62, 95%?CI 1.02-2.61). CONCLUSIONS:Physicians serving rural areas need to stress the importance of preventive interventions for heart failure, pneumonia and influenza to reduce the number of admissions for ACSCs. Contrary to previous studies, our findings might be explained by close patient-doctor relationships on the rural islands.

SUBMITTER: Kaneko M

PROVIDER: S-EPMC6936984 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study.

Kaneko Makoto M Aoki Takuya T Funato Masafumi M Yamashiro Keita K Kuroda Kaku K Kuroda Moe M Saishoji Yusuke Y Sakai Tatsuya T Yonaha Syo S Motomura Kazuhisa K Inoue Machiko M

BMJ open 20191229 12

<h4>Objectives</h4>The rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there wa ...[more]

PMID: 31888923

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Project description:BackgroundThe COVID-19 pandemic and the need for physical distancing has led to rapid uptake of virtual visits to deliver ambulatory health care. Despite widespread adoption, there has been limited evaluation of the quality of care being delivered through virtual modalities for ambulatory care sensitive conditions (ACSCs).ObjectiveTo characterize patients' and providers' experiences with the quality and sustainability of virtual care for ACSCs.DesignThis was a multi-method study utilizing quantitative and qualitative data from patient surveys, provider surveys, and provider focus groups at a large academic ambulatory care hospital between May 2020 and June 2021. We included patients and providers utilizing telephone or video visits for the following ACSCs: hypertension, angina, heart failure, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, or asthma.Main measuresQuantitative and qualitative patient and provider survey responses were mapped to the Six Domains of Healthcare Quality framework. Provider focus groups were coded to identify themes within each quality domain.Key resultsSurveys were completed by 110/352 (31%) consenting patients and 20/61 (33%) providers. 5 provider focus groups were held with 14 participants. Patients found virtual visits to be generally more convenient than in-person visits for ACSCs. The perceived effectiveness of virtual visits was dependent on the clinical and social complexity of individual encounters. Respondents reported difficulty forming effective patient-provider relationships in the virtual environment. Patients and providers felt that virtual care has potential to both alleviate and exacerbate structural barriers to equitable access to care.ConclusionsIn a large academic ambulatory care hospital, patients and providers experienced the quality of virtual visits for the management of ACSCs to be variable depending on the biopsychosocial complexity of the individual encounter. Our findings in each quality domain highlight key considerations for patients, providers and institutions to uphold the quality of virtual care for ACSCs.

Project description:BACKGROUND:The teach-back method, also known as the "show-me" method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. OBJECTIVES:To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). DESIGN:A matched cohort study. SETTING:Data from the 2011-2015 Longitudinal Medical Expenditure Panel Survey (panels 16-19). PARTICIPANTS:Three thousand nine hundred ninety-four US adults aged ??18 years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). MEASUREMENTS:Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. RESULTS:Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3 days [IQR 1 to 8 days] and median 3 days [IQR 0 to 8 days], respectively; P?= 0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. LIMITATION:Teach-back exposure relied on patient self-reported information. CONCLUSIONS:Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs.

Project description:BACKGROUND:Ambulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal. METHODS:A modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions. RESULTS:After three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus. CONCLUSIONS:New ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.

Project description:BACKGROUND:In 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs). OBJECTIVE:To measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision. DESIGN:National Hospital In-patient Enquiry System data were used to calculate 2011-2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR). RESULTS:In 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined. CONCLUSIONS:Prioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC's in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC's from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

Dataset Information

Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study.

Publications

Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study.

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