Ambulatory care-sensitive conditions: their potential uses and limitations

Emergency admission rates for ambulatory care-sensitive conditions (ACSCs) have been used by both researchers and policy makers as an indicator to assess healthcare systems.1–3 ACSCs are a set of conditions such as asthma and diabetes, where the need for emergency admissions is thought to be avoidable.4 5 They are designed to capture how ambulatory care might impact on rates of emergency admissions. However, in this issue of BMJ Quality and Safety , Lynch et al 6 question the merits of distinguishing ACSCs from other emergency admissions. Examining factors associated with county-level variation in emergency admissions in Ireland, they found similar factors were associated with both all emergency admissions and ACSCs. Lynch and colleagues concluded that ‘the distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed’.6 Here, we discuss the value of using ACSCs. We argue that they give important information on potentially avoidable demand for healthcare, but can only be used as an effective indicator after accounting for the drivers of demand for care that are common to all hospital admissions. Further, to reduce potentially avoidable emergency admissions, we must understand the mechanisms which link population factors such as deprivation to higher ACSC admission rates. In addition to understanding demand, ACSCs can provide indirect insights into the quality of ambulatory care provided, although it is important to recognise that they do not capture all facets of high quality care. Policy makers generally seek to reduce emergency hospital admission rates (ie, where a patient is admitted to hospital urgently and the admission is unplanned). Emergency admissions to hospitals carry risks to patients; for vulnerable patients, even short admissions can lead to infection, loss of mobility or increased frailty from inactivity. If treatment is unavoidable, many patients would prefer to be …