Hospitalization for ambulatory care-sensitive conditions: A method for comparative access and quality studies using routinely collected statistics

Background: Appropriate and timely provision of ambulatory care is an important factor in maintaining population health and in avoiding unnecessary hospital use. This article describes conditions for which hospitalization rates have a strong and inverse relationship to access to high-quality ambulatory care. Methods: Three panels of Canadian physicians following different consensus techniques selected conditions for which the relative risk of hospitalization is inversely related to ambulatory care access. Principal Findings: All panels identified asthma angina pectoris, congestive heart failure, otitis media, gastric ulcer, pelvic inflammatory disease, malignant hypertension, and immunization-preventable infections as ambulatory care-sensitive admissions. These conditions strongly overlap with lists developed for similar purposes in the U.S. and England. Interpretation: Ambulatory care-sensitive conditions represent an intermediate health outcome. They are distinct from inappropriate hospitalizations. They may be useful for measuring the impact of health care policy, and for performance measurement or audit.