Hospitalizaciones evitables por "Ambulatory Care Sensitive Conditions" en la Comunidad Valenciana 1996-2000variabilidad geográfica por areas de salud y posibles factores asociados en los municipios del área 06

Abstract

The hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) constitute an indicator of hospital activity that can be used as an indirect measure of the capacity of resolution and the effectiveness of the Primary Care (AP). Its development is relatively new in Spain.. The purpose of this work is to study the actions of this indicator in the Valencian Community (Comunidad Valenciana /CV) OBJECTIVES: To study the preventable hospitalizations for ACSC in the CV (period 1996 - 2000) by evaluating their extent, their geographic variability and their seasonal evolution. And through this study, to determine any factors that might be associated with variability amongst municipalities of Health District 06 of the CV. DESIGN: The study is ecological, retrospective and descriptive with analytical components. LOCATION: The study was realized in three geographic zones: the CV, Health Districts, and Municipalities of Health District 06. PRINCIPAL MEASUREMENTS: Utilizing listings of ACSC, both complete and limited (87 and 35 codifications, respectively), the rate of hospitalization was calculated with an IC of 95%, and percentages of hospitalizations for ACSC.. The tests were done using Chi-square, variance analysis, and multiple regressions. SOURCES OF DATA: CMBD and other sources of official data. RESULTS AND CONCLUSIONS: The percentage of admissions for ACSC in the CV was 17.15 for the complete listing, and 9.1 for the limited listing (Standardized Rate 118.9 and 63.5, respectively. Just the top four diagnoses accounted for 51% of the total admissions for ACSC. Significant differences in admission rates for ACSC were seen at the level of Health Districts. The action of the indicators at the municipal levels of Health District 06 was similar in all aspects to that in the entire CV. Study of the correlations showed that the data of the configurations of the centers were not associated with the admissions, and the data of the service activity showed disparate results. The crona to the hospital showed significant correlation. The higher social classes (indirectly measured) showed a lower rate of admissions. The results obtained from the analytical studies show that a higher percentage of the variability can be explained by variables in the difficult clinical interpretations, possibly due to the very design of the study (small and homogenous area, collineality, etc.). That data should be the object of future investigations with a different design study.