THE MEANING OF AMBULATORY CARE SENSITIVE ADMISSIONS - URBAN AND RURALPERSPECTIVES

Ambulatory care sensitive admission rates have been proposed as measur es of access to health care. To test this, admissions for ambulatory c are sensitive conditions (ACSC) were analyzed by multiple linear regre ssion. The percentage of population below 200 percent of the federally defined poverty level, the percentage of black people, and the number of primary care providers per 1,000 population were found to be posit ively associated with ACSC admissions. Population density was negative ly associated with ACSC admissions. There was no association between t he location of the ZIP code in a health professional shortage area and ACSC admissions. Proximity to the hospital was found to be positively associated with ACSC admissions but was examined only in the most rur al ZIP code group. The significant independent variables and the direc tion of their effects were the same across all ZIP code groups. The an alysis suggests that high ACSC admissions may be a reflection of defic its in one or more of the following areas: primary care availability, accessibility, or appropriateness. In-depth study is needed to determi ne the relative importance of these factors in a given geographical ar ea. There also may be environmental and social factors external to the health care system that contribute to ACSC admissions. The findings s uggest that ASC should be used cautiously as a measure of primary care system needs, and in conjunction with other health, demographic, or s ervice utilization data.