Show Ambulatory Care Sensitive Hospitali ions More thanMeasure of Bed Supply Jingyang Wu S Marlene Eqger Ph Gulzar Shah Ph Lois Haggard Ph Sandra Assassnik A Abstract Ambulatory Care Sensitive Hospitalizations ACSH are those hospitalizations for illnesses that are usually effectively treated in ambulatory care settings Elevation of ACSH rates ingiven area suggests that there are barriers to access to primary care Wennberg recently argued that ACSH reflect the local bed supply and not access to primary care The 1992-1996 Utah Hospital Discharge Data for asthma pneumonia and diabetes hospitalizations show that local socioeconomic status and rurality provide additional information about ACSH in Utah even after adjusting for local bed supply Therefore Wennbergfinding did not negate the use of ACSH as indicator of warning flags of possible access barriers access to primary care Three Utah ACSH Introduction those for asthma pneumonia and diabetes In rural frontier areas such as exist in Utah were chosen since they occur frequently and assuring access to primary care is of concern to patients health care providers respond well to primary care Connell Day and public health personnel alike The Utah LoGerfo 1981 Conway Philips Department of Health Bureau of Primary Panday 1990 The three ACSH were Care Rural and Ethnic Health periodically examined to determine whether Wennbergperformsstatewide Primary Care Needs concern might invalidate their use as administrative including Assessment administrative indicators of access to indicators of need as well as community primary care in Utah feedback Bureau of Primary Care Rural and Ethnic Health Ambulatory Care Methods Sensitive Hospitalizations ACSH were Hospital Discharge Data for the 61 Utah recently proposed asuseful addtion to this small areas created by Haggard and Shah assessment The idea of ACSH was 1999 were provided for 1992-1996 by one developed by the Institute of Medicine to of the authors GS Haggard and Shah identify hospitalizations some of which could divided the state into 61 small areas with have been delayed or prevented if adequate approximately similar population sizes by primary care had been available Millman pooling contiguous zip code areas Use of 1993 Not all ACSH can or should be these small areas givesmore detailed look prevented but high ACSH rates are thought at health in Utah particularly in urban areas to be an indication of poor access to primary than data aggregated up to the county level health care ACSH have been found to be The selected indicators were asthma associated with provider supply Parchman hospitalizations in children 0-19 years old 1995 local socioeconomic status Billings diabetes hospitalizations in adults and Teicholz 1990 Billngs Anderson elderly 20 years old and pneumonia Newman 1996 Billings Seitel et al 1993 hospitalizations in elderly 65 years old and other features of access to primary care This choice of indicators was based on the Bindman Grumbach Osmond Vranizan frequency of their occurrence as well as Stewart 1996 Bindman Grumbach their use in the National Healthcare Cost Osmond Vranizan Komaromy et al 1995 And Utiization Project Agency for Komaromy et al 1996 Recently however Healthcare Research and Quality Wennberg 1999 analyzed ACSH fromnational sample of hospitals and found that 1990 US Census data on features of access they were explained by the bed supply in the were obtained at the zip code level and local service area and not by features of combined for the 61 small areas Variables 17 Digital image 2005 Marriott Library University of Utah Al rights reserved |