Healthcare Commissioning Forum

Ambulatory or primary care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care (Bindman et al 1995; Purdy et al 2010c). At present, different sets of ACSCs are used in different situations. The most common ACSCs in England are based on a set of conditions initially derived to measure access to primary care in the United States; these were then refined for use in Australia (Agency for Healthcare Research and Quality 2001; NHS Institute for Innovation and Improvement 2007).

Some admissions (eg, those for dementia) may not be perceived to be avoidable, as the disease course is not significantly modifiable. However, the availability of more suitable alternatives to an acute hospital admission – for example, respite care or home care – can result in admission avoidance in the acute situation. This concept of an ACSC, which is dependent on availability and referral to an alternative service, is very different to the original American concept of the ACSC as a marker of availability of traditional clinical ambulatory or primary care.

Commissioners and other stakeholders will inevitably prioritise the conditions that  are of interest to them according to different criteria, which will vary depending on the viewpoint of the stakeholder. These priorities will also vary across health care systems, depending on the prevalence of the ACSCs and the economic and policy drivers in the local health care economy.

Recommendation:
   Commissioners need to be clear about which admissions they consider to be avoidable, what proportion of these admissions are avoidable, and how these admissions should be coded and measured.

For further information, please visit:  http://www.kingsfund.org.uk/sites/files/kf/Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf