Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition

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atmire.migration.oldid3916
dc.contributor.advisorQuan, Hude
dc.contributor.authorWalker, Robin
dc.contributor.committeememberGhali, William
dc.contributor.committeememberRabi, Doreen
dc.contributor.committeememberDixon, Elijah
dc.contributor.committeememberJette, Nathalie
dc.date.accessioned2015-12-16T18:39:48Z
dc.date.available2015-12-16T18:39:48Z
dc.date.issued2015-12-16
dc.date.submitted2015en
dc.description.abstractWith high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. ACSC are promising healthcare quality indicators widely used internationally, potentially creating opportunity for health care system quality improvement. The overall aim of this thesis was to explore, assess and evaluate ACSC hospitalization as a healthcare quality indicator for one condition, uncomplicated hypertension. We conducted three studies to achieve the aim. Our first study explored ACSC hospitalization rates for uncomplicated hypertension, taking into account important patient characteristics among hypertensive patients. Using population-based data in four provinces we found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, potentially indicating improvement in community care. We found geographic variations in the rate of hospitalizations, potentially signifying disparity among the provinces and those residing in rural versus urban regions. Our second study examined the association between ACSC hospitalizations for uncomplicated hypertension and previous primary care physician (PCP) utilization. Among this population-based cohort of hypertensive patients we found as the frequency of hypertension-related PCP visits increased the adjusted rate of ACSC hospitalizations also increased, even when stratified by demographic and clinical variables. This suggests that hospitalization for uncomplicated hypertension is not reduced with increasing frequency of PCP visits and may not be an appropriate indicator to measure and evaluate patients’ access to primary care. Our final study tested inter-physician reliability of judgments of avoidable hospitalizations for uncomplicated hypertension derived from medical chart review. We found a low proportion of ACSC hospitalizations were rated as avoidable, with poor agreement between physician raters. These findings point either to a need to abandon the use of the ACSC entirely; or alternatively a need to develop explicit criteria for judging avoidability. This research has provided crucial information for the interpretation of ACSC findings for uncomplicated hypertension. The results indicate that the use of this health quality indicator is questionable and may not provide information that is applicable for interventions to improve quality of primary care. At present, ACSC are most appropriately used as a starting point for assessing potential issues in the community which would then require further, more in-depth analysis.en_US
dc.identifier.citationWalker, R. (2015). Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26381en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/26381
dc.identifier.urihttp://hdl.handle.net/11023/2688
dc.language.isoeng
dc.publisher.facultyGraduate Studies
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectEpidemiology
dc.subjectHealth Care Management
dc.subject.classificationhealth care quality indicatoren_US
dc.subject.classificationambulatory care sensitive conditionsen_US
dc.subject.classificationhypertensionen_US
dc.subject.classificationprimary careen_US
dc.titleHospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition
dc.typedoctoral thesis
thesis.degree.disciplineCommunity Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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