Avoidable admissions and repeat admissions: what do they tell us?

eady access to primary healthcare is a desire of governments, healthcare providers and the public. One indicator that is recognized as an indirect measure of access to and quality of primary healthcare is the rate of hospitalization for ambulatory care sensitive conditions (ACSCs). An ACSC hospitalization, also known as a potentially preventable hospitalization, is one in which an individual is admitted for a condition that under most circumstances is manageable on an outpatient basis. While not all admissions for these conditions are avoidable, “timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease or condition” (Billings et al. 1993: 163). In this context, a disproportionately high rate may reflect problems in obtaining access to primary healthcare, differences in communityor hospital-based practice patterns or other factors. The conditions captured under this definition include angina, asthma, chronic obstructive pulmonary disease (COPD), congestive heart disease, diabetes, epilepsy and hypertension. This list is a subset of a larger selection of conditions developed by Billings et al. (1993) in a consultative process using a diagnostic framework for assessing hospital use. In 2004–2005, ACSC hospitalizations accounted for 5.1% of all acute care in-patient hospitalizations in Canada for persons less than 75 years of age at admission discharged alive, and ranged from 3.3% to 7.2% among the provinces and territories. CIHI Survey