Hospitalization for ambulatory care-sensitive conditions: A method for comparative access and quality studies using routinely collected statistics

Background: Appropriate and timely provision of ambulatory care is an impor tant factor in maintaining population heath and in avoiding unnecessary hos pital use. This article describes conditions for which hospitalization rats have a strong and inverse relationship to access to high-quality ambulator y care. Methods: Three panels of Canadian physicians following different consensus techniques selected conditions for which the relative risk of hospitalizati on is inversely related to ambulatory care access. Principal Findings: All panels identified asthma angina pectoris, congestiv e heart failure, otitis media, gastric ulcer, pelvic inflammatory disease, malignant hypertension, and immunization-preventable infections as ambulato ry care-sensitive admissions. These conditions strongly overlap with lists developed for similar purposes in the U.S. and England. Interpretation: Ambulatory care-sensitive conditions represent an intermedi ate health outcome. They are distinct from inappropriate hospitalizations. They may be useful for measuring the impact of heath care policy, and for p erformance measurement or audit.