Characteristics of ambulatory care sensitive condition visits to the emergency department at Chaophyaabhaibhubejhr Hospital in Thailand
Keywords:
ED overcrowding, ED outcomes, Ambulatory Care Sensitive Condition (ACSC), Primary care serviceAbstract
Context: Overcrowding of the Emergency department (ED) directly impacts patient and
personnel safety. To reduce overcrowding, we need to look at whether patients are receiving
timely and effective primary care, in order to increase potentially preventable admissions,
Objective: To analyze the characteristics of non-trauma patient visits to the ED with ambulatory
care sensitive conditions (ACSCs), and to compare the ED outcomes between ACSC and nonACSC admissions.
Materials and Methods: We retrospectively analyzed the characteristics of ED visits for ACSC
at the Chaophyaabhaibhubejhr hospital from October 2017 to September 2021. ACSCs were
defined by the primary ED diagnosis using Agency of Health Research and Quality (AHRQ) criteria.
Inclusion criteria were non-traumatic injuries in patients aged eighteen or older. Descriptive
statistics were performed to analyze the characteristic of the ACSC visits. Logistic regression
analysis was used to determine the association between patient demographics and ACSC visits.
Independent t and Chi-square tests were obtained to compare ED outcomes with ACSC and
non-ACSC visits.
Results: From 2017 to 2021, ACSC visits have continuously increased from 13.08% to 16.27%
respectively. Patient demographics across ACSC visits to the ED were grouped by gender, age,
insurance, triage, and frequency of ED visits (4 or more per year). It was reported that the
number of patients with an ED length of stay (LOS) > 2-hours, the ED cost, admission rate and
ED mortality rate were significantly higher in ACSC visits as compared to non-ACSC visits.
Conclusion: There was an increase of ACSC visits in ED. The characteristics of these ACSC
visits to the ED can be associated by gender, age group, insurance, triage, and the frequency
of admission. ED outcomes, including LOS, ED cost, admission rate, and ED mortality rate were
higher in ACSC admissions
References
departments: a critical review. Ann Emerg
Med. 2011; 57: 265-78.
2. Bucci S, de Belvis AG, Marventano S, De
Leva AC, Tanzariello M, Specchia ML, et
al. Emergency Department crowding and
hospital bed shortage: is Lean a smart
answer? A systematic review. Eur Rev Med
Pharmacol Sci. 2016; 20: 4209-19.
3. Hoot NR, Aronsky D. Systematic review of
emergency department crowding: causes,
effects, and solutions. Ann Emerg Med.
2008; 52: 126-36.
4. Morley C, Unwin M, Peterson GM,
Stankovich J, Kinsman L. Emergency
department crowding: A systematic review
of causes, consequences and solutions.
PLoS One. 2018; 13: e0203316.
5. Hooker EA, Mallow PJ, Oglesby MM.
Characteristics and Trends of Emergency
Department Visits in the United States
(2010-2014). J Emerg Med. 2019; 56: 344-
51.
6. Berchet C. Emergency care services: trends,
drivers, and interventions to manage the
demand. OECD Health Working Papers
2015. No.83
7. Department of Medical Services. Guideline
for ER service delivery. Nontaburi: Academic
office of Department of Medical Services;
2018. Thai
8. Jeyaraman MM, Copstein L, Al-Yousif N,
Alder RN, Kirkland SW, Al-Yousif Y, et al.
Interventions and strategies involving
primary healthcare professionals to manage
emergency department overcrowding:
a scoping review. BMJ Open. 2021; 11:
e048613.
9. Richardson DB, Mountain D. Myths
versus facts in emergency department
overcrowding and hospital access block.
Med J Aust. 2009; 190: 369-74.
10. Berger S, Szecsenyi J, Laux G, Leutgeb
R. Ambulatory Care-Sensitive Conditions
Associated With Potentially Avoidable
Hospital Admissions. J Am Med Dir Assoc.
2020; 21: 555.
11. Purdy S, Griffin T, Salisbury C, Sharp D.
Ambulatory care sensitive conditions:
terminology and disease coding need to
be more specific to aid policy makers and
clinicians. Public Health. 2009; 123: 169-73.
12. Frick J, Mockel M, Muller R, Searle J,
Somasundaram R, Slagman A. Suitability
of current definitions of ambulatory
care sensitive conditions for research
in emergency department patients: a
secondary health data analysis. BMJ Open.
2017; 7: e016109.
13. Johnson PJ, Ghildayal N, Ward AC,
Westgard BC, Boland LL, Hokanson
JS. Disparities in potentially avoidable
emergency department (ED) care: ED visits
for ambulatory care sensitive conditions.
Med Care. 2012; 50: 1020-8.
14. Hsieh VC, Hsieh ML, Chiang JH, Chien
A, Hsieh MS. Emergency Department
Visits and Disease Burden Attributable to
Ambulatory Care Sensitive Conditions in
Elderly Adults. Sci Rep. 2019; 9: 3811.
15. Director Bureau of Strategy and Planning,
Office of Permanent Secretary, Ministry of
Public Health. Health Key Performance
Indicators fiscal year 2019 [Internet].2019
[accessed August 1, 2021]. Available from:
https://bps.moph.go.th/new_bps/sites/
default/files/template62_edit3.pdf
16. E m e r g e n c y D e p a r t m e n t ,
Chaophyaabhaibhubejhr Hospital. Service
Profile. Prachinburi;2563
17. Agency for Healthcare Research and
Quality. Prevention Quality Indicators
Technical Specifications-version v2021
[Internet].2021 [accessed August 10,
2021]. Available from: https://www.
qualityindicators.ahrq.gov/Modules/PQI_
TechSpec_ICD10_V2021.aspx
18. Hudon C, Courteau J, Chiu YM, Chouinard
MC, Dubois MF, Dubuc N, et al. Risk of
Frequent Emergency Department Use
Among an Ambulatory Care Sensitive
Condition Population: A Population-based
Cohort Study. Med Care. 2020; 58: 248-56.
19. Galarraga JE, Mutter R, Pines JM. Costs
associated with ambulatory care sensitive
conditions across hospital-based settings.
Acad Emerg Med. 2015; 22: 172-81.
20. Billings J, Zeitel L, Lukomnik J, Carey
TS, Blank AE, Newman L. Impact of
socioeconomic status on hospital use in
New York City. Health Aff (Millwood). 1993;
12: 162-73.
21. Weissman JS, Gatsonis C, Epstein AM. Rates
of avoidable hospitalization by insurance
status in Massachusetts and Maryland.
JAMA. 1992; 268: 2388-94.
22. Bindman AB, Grumbach K, Osmond D,
Komaromy M, Vranizan K, Lurie N, et al.
Preventable hospitalizations and access
to health care. JAMA. 1995; 274: 305-11.
23. Cheung PT, Wiler JL, Lowe RA, Ginde
AA. National study of barriers to timely
primary care and emergency department
utilization among Medicaid beneficiaries.
Ann Emerg Med. 2012; 60: 4-10.
24. Oster A, Bindman AB. Emergency
department visits for ambulatory
care sensitive conditions: insights into
preventable hospitalizations. Med Care.
2003; 41: 198-207.
