Severity of illness and ambulatory care sensitive conditions

Purpose. This dissertation is a study of hospitalizations for two chronic health conditions, diabetes and asthma, chronic conditions (ambulatory care sensitive conditions or ACSCs) that with proper access to primary medical care can be well-managed in ambulatory settings. Hospitalization for these conditions may indicate problems or deficiencies in that care. The goal of this study is to describe factors and quantify costs that may be associated with these two ACSCs, as well as to discuss implications of these findings in planning and public health contexts. Methods. Geographically-based rates of hospitalization for diabetes and asthma, two ambulatory care sensitive conditions (ACSCs) are studied in relationship to access to care, population-based demographics, and hospital costs. Included in the ACSC definition is a severity of illness measure. Stratified rates as well as adjusted hospitalization rates are presented. Data from Pennsylvania Health Care Cost Containment Council, the Philadelphia Health Management Corporation, the Census, and the American Medical Association Physician Master-file was used. Results. Access to care was not found to be associated with rates of high severity ACSCs. Education was significantly associated with both high and low hospitalization severity ACSCs. These findings indicate that low severity (rather than high severity) ACSCs may be more sensitive to ambulatory care. GIS maps indicated a wide geographic ranges of hospitalization rates and cost per capita, even after adjusting for age, race, and gender; also showing is that asthma and diabetes are not solely problems of the inner city, urban areas. Conclusions. Populations at increased risk of receiving inadequate disease prevention and promotion services for asthma and diabetes have been identified through a refined measure of ACSCs by including dimensions of severity of illness. The applicability of this measure has the potential to be widespread and easily used to develop public policy and refine financing mechanisms. As it relies upon the use of routinely generated administrative data, data collection efforts may be minimized. Conditions may be profiled for large and/or broadly defined populations. The additional component of GIS analysis allows for the display of patterns of care that are easily disseminated to different stakeholder groups