Ambulatory care sensitive conditions

Development of Ambulatory Care Sensitive Conditions (ACSC) in Thai Context:

Hospitalization Rates for ACSC as Indicator of Access and Quality in Primary Care

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สำำน ักงำนว ิจ ัยเพ ื่อกำรพฒันำหลักประกนัส ุขภำพไทย เคร ือ สถำบ ันว ิจ ัยระบบสำธำรณสุข

Arnat Wannasri. (Master student: NU; HISRO);Nipaporn, S., Inmai, P., Sakunphanit, P., Srithamrongsawat, S., (HISRO); Suriyawongpaisal, P. (Faculty of Medicine Ramathibodi Hospital, Mahidol University)

Introduction

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สำำน ักงำนว ิจ ัยเพ ื่อกำรพัฒนำหลักประก ันส ุขภำพไทย เคร ือ สถำบ ันว ิจ ัยระบบสำธำรณสุข

• ACSCs are those conditions for which hospitalization could be prevented by interventions in primary care.

• In many countries, hospitalization rates for ACSC are used as a proxy for analyzing the quality of and access to

primary care services.

• Poor access and low quality of primary care higher hospitalization rates with ACSC.

IntroductionH

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•Healthcare infrastructures in Thailand have been developed for many decades to improve access to health care and equity

of service utilization across the country.

•Three levels of health care service system: Primary, Secondary and Tertiary.

•Outpatient utilization rate: 2.45 visits/person in 2003 3.22 visits/person in 2010.

•Better accessibility and what about the quality? population-based surveys!

•ACSC rate as indicator: helps states assess the quality of and access to primary health care services, but “what is ACSC list of Thailand?”

Aim of study

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•Thailand has not yet been established this tool.

•“The aim of this study is to develop an ACSC list in Thai context based on consensus among Thai health

professionals”.

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• Qualitative study: Delphi technique

• Working process as following:

1) The ACSC criteria: applied Caminal et al (2004)

- hospitalization rates of at least 1/10,000 populations;

- clarity in definition and ICD coding and;

- potentially preventable or avoidable through primary care services.

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2) The health professional’s criteria: - have experiences with primary care system more than

10 years

3) Questionnaire development

- Review of international and national literature

- Identified ICD-9, ICD-10 and procedure codes

- Analysing of hospitalization rates of each ICD code: using public health insurance database of 3 health

schemes - Making a questionnaire

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4) Selection ACSC list: Consensus panel process

- 15 professionals give opinions: relationship between ICD-code and primary care in the Thai context.

- 2 rounds for consensus (during July and August, 2013)

- Kappa test: analysing consensus level ( 0.41)≥ Kappa Interpretation

< 0 Poor agreement

0.0 – 0.20 Slight agreement

0.21 – 0.40 Fair agreement

0.41 – 0.60 Moderate agreement

0.61 – 0.80 Substantial agreement

0.81 – 1.00 Almost perfect agreement

Result: Literature review

THAU.S.A. BRAAUSCANESPUKTPEITL1 Acute Poliomyelitis √2 Angina √ √ √ √ √ √ √ √4 Asthma √ √ √ √ √ √ √ √ √6 Bacterial pneumonia √ √ √ √7 Cardiac insufficiency √14 COPD √ √ √ √ √ √ √ √31 Heart failure √32 Hypertension √ √ √ √ √ √ √ √34 Hypoglycemia √35 Hypokamlemia √36 Immunization and preventable √ √ √ √37 Infectious diseases √39 Influenza and pneumonia √ √ √44 Nutritional deficiencies √ √ √ √47 Pelvic inflammatory disease √ √ √ √ √ √ √54 Seizure Disorder √60 Urinary tract infections √ √

No. Disease groupsCountries

Result: Literature reviewNo. Disease groups ICD-10 ICD-9

1 Acute Poliomyelitis 045.00, 045.10, 045.20, 045.90

2 AnginaI20, I23.82, I24 (Exclude cases with procedure codes 01 - 86.99)

411, 411.1, 411.8, 413

4 Asthma J45, J46 493

14 COPD

J10.0, J11.0, J12-J16, J18, J20-J21, J22, J41-J44, J47, (J20: with secondary diagnosis of J41-J44, J47), (J10.0, J11.0, J12-J16, J18, J22: with secondary diagnosis of J44)

491, 492, 494, 496, (466.0 with secondary diagnosis of 491, 492, 494, 496)

16Dehydration and gastroenteritis

E86, K52.2, K52.8, K52.9,

18 Dental conditionsA69.0, K02-K06, K08, K09.8, K09.9, K12, K13

521, 522, 523, 525, 528

20 Diabetes mellitus E10-E14 250.1, 250.2, 250.3, 250.7, 785.40

26Ear, Nose and Throat infections

H66, H67, J00-J03, J06, J31, I00-I02

33 HypertensionI10, I11 (Excluding cases with caridac procedures 33.6,35, 36, 37.3, 37.5, 37.7, 37.8, 37.94, 37.98)

401.0, 401.9, 402.0, 402.1, 402.9, 403.0, 404.0, 405.0, 437.2

37Immunization and preventable infectius diseases

A15-A18, A33-A37, A50,-A53, A80, A95, B05, B06, B16, B18.0, B18.1, B26, B50-B54, B77, G00.0, I00-I02, M01.4

033, 037, 072, 045, 055, 320.0, 390, 391., 037, 045, 320.0

60 Urinary tract N10, N11, N12, N13.6, N39.0 590.0, 590.1, 590.8, 590.9

Result: ICD-9 converts into ICD-10Diseases ICD-9 codes Diseases ICD -10

045.00Acute paralytic poliomyelitis specified as

bulbar, poliovirus, unspecified type A80.0,A80.1,A80.2

045.10Acute poliomyelitis with other paralysis,

poliovirus, unspecified type A80.3

045.20Acute nonparalytic poliomyelitis,


045.90Acute poliomyelitis, unspecified,


411Other acute and subacute forms of

ischemic heart disease I24.8,I24.9

411.1 Intermediate coronary syndrome I20.0

411.8Other acute and subacute forms of ischemic heart disease I24.8

413 Angina pectoris I20.0,I20.1,I20.8,I20.9

Acute Poliomyelitis

Angina

Next step

• Consensus panel round 1

Kappa test analysis

ICD codes with lower consensus level ( 0.41) will be ≤

excluded.

All relevant data will be used for the second round

• Consensus panel round 2

Kappa test analysis ICD codes with accepted consensus level will be used as

ACSC list in the Thai context.

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Ambulatory care sensitive conditions

Health & Medicine

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