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Variation in hospital discharges for ambulatory care-sensitive conditions among children
1Infant and Child Health Studies Branch, National Center for Health Statistics, Hyattsville, Maryland, USA. jdparker@cdc.gov
Insights
Ambulatory Care-Sensitive Conditions (ACSCs) hospitalization rates are higher in younger, Black children, and those in poorer areas. However, these rates may not be comparable across all child subgroups due to varying index behaviors.
Area of Science:
- Pediatric Health Services Research
- Public Health Policy
- Healthcare Disparities
Background:
- Ambulatory Care-Sensitive Conditions (ACSCs) are indicators of primary care adequacy.
- Few studies have specifically examined ACSCs in pediatric populations.
- Understanding pediatric ACSC hospitalization rates is crucial for assessing primary care access.
Purpose of the Study:
- To estimate national hospitalization rates for ACSCs among children.
- To analyze how ACSC hospitalization rates differ across various child subgroups.
- To evaluate the utility of ACSCs as an index for primary care in diverse pediatric populations.
Main Methods:
- Utilized data from 1990-1995 National Hospital Discharge Surveys (NHDS).
- Incorporated US census and National Health Interview Survey (NHIS) data for population estimates.
- Calculated condition-specific hospitalization rates relative to the population at risk.
Main Results:
- Higher ACSC hospitalization rates were observed in younger children, Black children, those with Medicaid, and children from poorer areas.
- Significant variations in the relationship between ACSCs and income were found among children.
- The distribution of specific ACSCs differed across subgroups, impacting the index's behavior.
Conclusions:
- ACSC hospitalization rates may reflect disparities in healthcare access and utilization among children.
- The varying behavior of the ACSC index across subgroups suggests caution when making cross-group comparisons.
- Further research is needed to refine the use of ACSCs for assessing pediatric primary care quality across diverse populations.
Objective:
Ambulatory Care-Sensitive Conditions (ACSCs), conditions for which ambulatory care may reduce, though not eliminate, the need for hospital admission, have been used as an index of adequate primary care. However, few studies of ACSC have focused on children. We estimated national hospitalization rates for ACSC among children and examined the behavior of the index between subgroups of children.
Methods:
We used data from the 1990-1995 National Hospital Discharge Surveys (NHDS), the US census, and the National Health Interview Survey (NHIS) to calculate hospital discharge rates. Rates were estimated as the number of condition-specific hospital discharges from the NHDS divided by the population at risk, as estimated from the US census and NHIS.
Results:
Predictably, ACSC hospitalization rates were significantly higher among children who were younger, black, had Medicaid insurance, and lived in poorer areas compared with their counterparts. However, the relationship between ACSCs and income and the distributions of conditions within the index varied significantly between children.
Conclusions:
ACSCs may indicate disparities in access and utilization of health care, however, the differing behavior of the index between subgroups suggests that inferences from examining rates of ACSCs may not be comparable for all children.ambulatory care-sensitive conditions, hospitalization rates.
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