Avoidable Hospitalization Trends From Ambulatory Care-Sensitive Conditions in the Public Health System in México

Area of Science:

• Public Health
• Healthcare Management
• Health Services Research

Background:

• Avoidable Hospitalization for Ambulatory Care Sensitive Conditions (AH-ACSC) serves as an indirect measure of primary care accessibility and quality.
• Understanding variations in AH-ACSC rates is crucial for identifying systemic weaknesses in healthcare delivery.

Purpose of the Study:

• To estimate and identify variations in AH-ACSC rates within Mexico's public health institutions between 2010 and 2017.
• To analyze trends and disparities in these hospitalizations across different conditions and healthcare providers.

Main Methods:

• Secondary analysis of the Ministry of Health's hospital discharge database (2010-2017).
• Calculation of AH-ACSC rates by age, sex, and institution using metrics like the extreme quotient (EQ), coefficient of variation (CV), and systematic component of variance (SCV).
• Trend analysis using Joinpoint Regression for adjusted AH rates by condition group (acute, chronic, vaccine-preventable).

Main Results:

• Overall AH-ACSC decreased from nearly 13% to 10.7% of discharges between 2010 and 2017.
• While all-cause AH-ACSC declined across institutions, significant variations were observed using SCV (≥3) in 2015-2017.
• Diabetes-related AH-ACSC rates were highest but showed declines, with notable reductions for angina (75%), diabetes/hypertension complications (38%), and heart failure (15%).

Conclusions:

• AH-ACSC rates reflect disparities in primary care access and quality across Mexican public health institutions.
• Observed variations in CV and SCV suggest potential inequities in service provision among different subsystems and states.
• Further in-depth analysis is needed to understand the multifaceted factors contributing to the burden of AH-ACSC in the Mexican Health System.