medicina61巻11号

2024年10月発行

増大号特集 続・Quality Indicatorの実装とその改善—日々の診療に役立つ診療評価指標

各論　プライマリ・ケア

ambulatory care sensitive conditions（ACSCs）の評価指標

著者： 阿部計大¹

所属機関： ¹北海道大学大学院保健科学研究院健康イノベーションセンターデータヘルス部門

ページ範囲：P.1798 - P.1801

文献概要

Point
◎ambulatory care sensitive conditions（ACSCs）とは，適切な外来診療によって入院を防ぎうる疾患や状態である．
◎ACSCsの入院率は地域住民のプライマリ・ケアに対する潜在的ニーズを示す1つの指標である．
◎ACSCsには3つのカテゴリ（急性，慢性，ワクチン接種で予防可能な状態）に19の疾患と状態が含まれ，おのおのが国際疾病分類（ICD-10）コードで規定されている．
◎ACSCs入院率を低減するためには，患者や患者家族，地域の行政や医療介護サービス，多職種が互いに密接に連携しながら，ガイドラインなどに沿ったケアを提供することが大切である．
◎電子カルテやレセプトデータから算出できるACSCs入院率は，行政や医療機関がプライマリ・ケアの質をモニタリングするために実用的である．

参考文献

1）Purdy S, et al：Ambulatory care sensitive conditions；Terminology and disease coding need to be more specific to aid policy makers and clinicians. Public health 123：169-173, 2009 PMID 19144363

2）Billings J, et al：Impact of socioeconomic status on hospital use in New York City. Health Aff（Millwood） 12：162-173, 1993 PMID 8509018

3）World Health Organization, United Nations Children's Fund：Primary health care measurement framework and indicators；Monitoring health systems through a primary health care lens. 2022　https://www.who.int/publications/i/item/9789240044210（2024年7月閲覧）

4）Kao YH, et al：Continuity of outpatient care and avoidable hospitalization；A systematic review. Am J Manag Care 25：e126-e134, 2019 PMID 30986022

5）Rosano A, et al：The relationship between avoidable hospitalization and accessibility to primary care；A systematic review. Eur J Public Health 23：356-360, 2013 PMID 22645236

6）Gibson OR, et al：A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing. BMC Health Serv Res 13：336, 2013 PMID 23972001

7）Busby J, et al：A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. BMC Health Serv Res 15：324, 2015 PMID 26268576

8）Wallar LE, et al：Socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions；A systematic review of peer-reviewed literature, 1990-2018. Int J Equity Health 19：60, 2020 PMID 32366253

9）Shinotsuka M, et al：Emergency admissions of ambulatory care sensitive conditions at a Japanese local hospital；An observational study. J Gen Fam Med 21：235-241, 2020 PMID 33304717

10）Katayama Y, et al：The characteristics and outcomes of patients transported by ambulance due to ambulatory care sensitive condition；A population-based descriptive study in Osaka, Japan. Front Public Health 10：911675, 2022 PMID 35844890

11）Iba A, et al：Hospitalizations for ambulatory care sensitive conditions in a large city of Japan；A descriptive analysis using claims data. J Gen Intern Med 37：3917-3924, 2022 PMID 35829872

12）Sasabuchi Y, et al：Increase in avoidable hospital admissions after the Great East Japan Earthquake. J Epidemiol Community Health 71：248-252, 2017 PMID 27612980

13）Sasabuchi Y, et al：Effect of the 2016 Kumamoto earthquakes on preventable hospital admissions；A retrospective cohort study in Japan. BMJ Open 8：e021294, 2018 PMID 30002010

14）Kaneko M, et al：Impact of COVID-19 infection rates on admissions for ambulatory care sensitive conditions；Nationwide difference-in-difference design in Japan. Fam Med Community Health 10：e001736, 2022 PMID 36241252

15）Abe K, et al：In-hospital deaths from ambulatory care-sensitive conditions before and during the COVID-19 pandemic in Japan. JAMA Netw Open 6：e2319583, 2023 PMID 37347480

16）Iba A, et al：Association between spatial access and hospitalization for ambulatory care sensitive conditions；A retrospective cohort study using claims data. SSM Popul Health 25：101565, 2023 PMID 38089850

17）Hirota Y, et al：Association between clinic physician workforce and avoidable readmission；A retrospective database research. BMC Health Serv Res 20：125, 2020 PMID 32070343

18）Kaneko M, et al：Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience；A multicentred prospective cohort study. BMJ Open 9：e030101, 2019 PMID 31888923

19）Duminy L, et al：Complex community health and social care interventions；Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review. Health Policy 126：1206-1225, 2022 PMID 36257866

20）Hodgson K, et al：Ambulatory care-sensitive conditions；Their potential uses and limitations. BMJ Qual Saf 28：429-433, 2019 PMID 30819838