Assessment of potentially avoidable hospitalizations in Ningxia, China: application of a China-specific ACSCs list

The China-specific list of ambulatory care sensitive conditions (ACSCs), comprising 14 conditions, represents the first evidence-based instrument for assessing primary health care (PHC) performance in China. However, this list has not yet been empirically applied to real-world data, and its feasibility and policy implications have not yet been evaluated.

The aim of this study was to apply a China-specific list of ACSCs to systematically evaluate, for the first time, the scale, distribution, and determinants of potentially avoidable hospitalizations in Ningxia. This assessment aimed to provide a foundation for enhancing PHC performance and optimizing resource allocation in other regions of China.

We extracted data from hospital discharge records in Ningxia for the period between 2022 and 2025. Generalized estimating equations were adopted to identify factors influencing potentially avoidable hospitalizations among patients.

The overall standardized rate of potentially avoidable hospitalizations in Ningxia was 505.37 per 100,000 population per year. Patients with chronic obstructive pulmonary disease (COPD) exhibited the highest rate of potentially avoidable hospitalizations (151.12 per 100,000 population per year). Local indicators of spatial association (LISA) identified Dawukou District and Jingyuan County as "high-high" hotspots, whereas Hongsibao District, Qingtongxia City, and Zhongning County were classified as "low-low" cold spots. Multivariate analysis indicated that age (65 years and older; OR = 4.367; 95% CI: 4.248-4.489), a high Charlson comorbidity index (CCI) score (3-4; OR = 4.557; 95% CI: 4.505-4.610), and the number of primary care beds per 1,000 population (OR = 1.166; 95% CI: 1.102-1.278) were significant risk factors for potentially avoidable hospitalizations. Conversely, female sex (OR = 0.786, 95% CI: 0.781-0.792), per capita gross domestic product (GDP) (OR = 0.846, 95% CI: 0.705-0.947), and the number of primary care physicians per 1,000 population (OR = 0.824, 95% CI: 0.742-0.915) were protective factors against potentially avoidable hospitalizations.

Notable differences in the rates of potentially avoidable hospitalizations and disease burden were identified in Ningxia, accompanied by significant spatial clustering and variations among different populations. Strengthening the allocation of primary-care physicians is a key intervention for reducing potentially avoidable hospitalizations.