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Using ACSC to monitor quality and equity. Supasit Pannarunothai. Ambulatory Care Sensitive Condition. Pulmonary tuberculosis , Gastroenteritis, Nutritional deficiencies, Diabetes , Hypoglycemia, Angina, Congestive heart failure (CHF), Hypertension , etc.

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Ambulatory care sensitive condition
Ambulatory Care Sensitive Condition

  • Pulmonary tuberculosis,

  • Gastroenteritis,

  • Nutritional deficiencies,

  • Diabetes,

  • Hypoglycemia,

  • Angina,

  • Congestive heart failure (CHF),

  • Hypertension, etc.


Ambulatory care sensitive condition1
Ambulatory Care Sensitive Condition

  • If the contracting unit for primary care (CUP)is of good quality, admissions of the ACSCs should be low.

  • Rate of ACSC is used to monitor the project of encouraging primary care unit (PCU) to take care chronic patients instead of hospitals (shifting load from hospital to PCU)

  • Rate for ACSC presented here:

    • All conditions

    • Specific conditions


Rural & Urban

PCU

Out of town district

(metropolitan)

Town district

(metropolitan)

Urban

PCU

District

hospital

Urban

PCU

Provincial

hospital

CUP

Rural

PCU

CUP

Shifting load

Rural

PCU

PCU

Network

(catchment area)

Rural

PCU

PCU

Network

(catchment area)

Rural

PCU

Rural

PCU

Rural

PCU

Rural

PCU

Rural

PCU

Rural

PCU

Rural

PCU

Rural

PCU

Rural

PCU

Sub district

in out of town district

nonmetropolitan

Sub district

in town district

nonmetropolitan

(Reungon 2007)


Data requirements
Data requirements

  • All admission data from hospitals (in 12-file standard dataset)

  • All ambulatory visits at hospitals (in 12-file standard dataset)

  • All ambulatory visits at PCUs or health centres (in 18-file standard dataset)


Results from 2 provinces
Results from 2 provinces

  • Shifting loads from a regional hospital

  • Shifting loads from a provincial hospital


Regional hospital
Regional hospital

Mueang

Province

DM

Hypertension


Provincial hospital
Provincial hospital

Mueang

Province

DM

Hypertension


Key findings
Key findings

  • RH admission forDM 5.5%, while 6% share of outpatient visits were at PCUs.

  • RH admission forHT 1.0%, while 13% share of outpatient visits were at PCUs.

  • PH admission for DM 11.2%, while 29% share of outpatient visits were at PCUs.

  • PH admission for HT 6.3%, while 40% share of outpatient visits were at PCUs.

ตัวอย่าง ACSC: Pulmonary tuberculosis, Gastroenteritis, Nutritional deficiencies, Diabetes, Hypoglycemia, Angina, Congestive heart failure (CHF), Hypertension, etc.


Key findings1
Key findings

RW for DRG

Diabetes

Hypertension

If 23% more DM were taken care at PCU, 11m baht saved at OP

And 27% more HT at PCU, 27m baht saved at OP


Discussions
Discussions

  • Can ACSC be used in Thailand?

  • What target can be set in Thailand?

  • How can we save hospital outpatient cost as well as inpatient cost?

  • Ethical aspect: whose saving and whose cost?


Primary care scores 1980s and 1990s
Primary Care Scores, 1980s and 1990s

*Scores available only for the 1990s

Starfield 10/02

02-185

Starfield 10/02

IC 2238


Primary care score vs health care expenditures 1997
Primary Care Score vs. Health Care Expenditures, 1997

UK

DK

NTH

FIN

SP

CAN

AUS

SWE

JAP

GER

US

BEL

FR

Starfield 10/00

00-133

Starfield 10/00

IC 1731


Relationship between strength of primary care and combined outcomes

USA

GER

BEL

AUS

SWE

CAN

SP

NTH

DK

FIN

UK

*1=best

11=worst

Relationship between Strength of Primary Care and Combined Outcomes

Starfield 1999

IC 1433

Starfield 1999

99-006


Primary care orientation of health systems

Primary Care Orientation of Health Systems

Health system characteristics (9)

Practice characteristics (6)

Adapted from Starfield. Primary Care: Balancing Health Needs, Services, and Technology. Oxford U. Press, 1998, Chapter 15.

Starfield 04/99

PC 1475

Starfield 1999

99-147


Primary care orientation of health systems rating criteria
Primary Care Orientation of Health Systems: Rating Criteria

  • Health System Characteristics

    • Type of system

    • Financing

    • Type of primary care practitioner

    • Percent active physicians who are specialists

    • Professional earnings of primary care physicians

      relative to specialists

    • Cost sharing for primary care services

    • Patient lists

    • Requirements for 24-hour coverage

    • Strength of academic departments of family medicine

Source: Starfield. Primary Care: Balancing Health Needs, Services, and Technology. Oxford U. Press, 1998.

Starfield 04/99

PC 1476

Starfield 1999

99-148


Primary care orientation of health systems rating criteria1
Primary Care Orientationof Health Systems:Rating Criteria

Each country was rated (scores of 0, 1, or 2) on the strength of 9 characteristics of health policy that are conducive to strong primary care.

Starfield 09/02

02-285

Starfield 09/02

PC 2197


Primary care orientation of health systems rating criteria2
Primary Care Orientation of Health Systems: Rating Criteria

  • Practice Characteristics

    • First-contact

    • Longitudinality

    • Comprehensiveness

    • Coordination

    • Family-centeredness

    • Community orientation

Source: Starfield. Primary Care: Balancing Health Needs, Services, and Technology. Oxford U. Press, 1998.

Starfield 04/99

PC 1477

Starfield 1999

99-150


Primary care orientation of health systems rating criteria3
Primary Care Orientationof Health Systems:Rating Criteria

The countries were also scored (0, 1, or 2) with regard to the strength of 6 key characteristics of primary care practice.

Starfield 09/02

02-286

Starfield 09/02

PC 2198


Primary care features consistently associated with good excellent primary care
Primary Care Features Consistently Associated with Good/Excellent Primary Care

  • System features

    • Regulated resource distribution

    • Government-provided health insurance

    • No/low cost-sharing for primary care

  • Practice features

    • Comprehensiveness

    • Family orientation

Starfield 10/01

PC 1983

Starfield 10/01

01-174


Issues after the conference
Issues after the conference Good/Excellent Primary Care

  • ACSC

  • Primary care score

  • ACG (Adjusted Clinical Group) vs Thai Out-Patient Group (T-OPG)

  • ICPC (International Classification for Primary Care)


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