Physicians ' Perceptions of Non-Medical Variables Influencing the Decision to Hospitalize Elderly Patients with Ambulatory-Care Sensitive Conditions

Abstract BACKGROUND. Hospitalization rates for chronic and acute ambulatory care sensitive conditions (ACSCs) were proposed by the Institute of Medicine as indices of access to care. Previous research showed a correlation with self-reported access and provider supply but not physician practice style when other factors were controlled. The present study developed and validated self-report measures of physician practice style to compare urbanlrural practice styles in the rurallfrontier inter-mountain west. METHODS. Paper patient scenarios involving one chronic and two acute ACSCs were rated by Utah physicians regarding the influence of pro-outpatient or pro-inpatient non-medical factors on the decision to admit in an equivocal case. Scales of pro-outpatient and pro-inpatient non-medical factors were developed, validated, and used to compare urban vs. rurallfrontier responses. RESULTS. 33 urban and 29 rural physicians responded to the survey (30 % response). Propensity to hospitalize equivocal cases varied with specific non-medical factors. Pro-outpatient factors were not homogeneously rated across diagnoses. A pro-inpatient summary scale was reliable, valid, and had significantly greater influence on self-rated rural/frontier admissions decisions than urban ones (p=0.041). CONCLUSIONS. Pro-inpatient non-medical factors appear to influence the self-reported decision to hospitalize patients with ACSCs more consistently than pro-outpatient non-medical factors in an inter-mountain west sample of physicians. Their influence appears stronger in rurallfrontier areas. Replication in a larger sample would be desirable