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Avoidable Hospitalizations for Ambulatory Care Sensitive Conditions as an Indicator of Primary Health Care Effectiveness in Argentina

Rubinstein, Adolfo MD, MSc, PhD; López, Analía MD; Caporale, Joaquín BSc, MSc; Valanzasca, Pilar MD; Irazola, Vilma MD, MSc; Rubinstein, Fernando MD, MPH

Journal of Ambulatory Care Management: January/March 2014 - Volume 37 - Issue 1 - p 69–81
doi: 10.1097/JAC.0000000000000008
Original Articles

Avoidable hospitalizations for ambulatory care sensitive conditions (AH-ACSCs) identify health problems that could be avoided by improving primary health care (PHC). On the basis of hospital discharges from Argentine public sector facilities, an expert panel convened to define a list of AH-ACSCs for children and adults. AH-ACSCs represented less than 30% of hospitalizations. Compared with country averages, poorer districts showed large differences in trends for adults but not for children. Despite that AH-ACSCs have demonstrated empirical validity to evaluate health system performance, its implementation to assess PHC in countries like Argentina, with pluralistic and fragmented health care systems, remains a big challenge.

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Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

Correspondence: Adolfo Rubinstein, MD, MSc, PhD, Ravignani 2024, Buenos Aires C1414CPV, Argentina (

The authors express their great appreciation to Graciela Ventura and her team at the Programa Remediar + Redes of the Argentine Ministry of Health for their technical assistance with the project. In addition, they specially thank the following primary care physicians who participated in the Delphi panels to select AH-ACSCs: Elvio Eduardo Actis, Iris Aguilar, Adrian Alasino, Mariano Althabe, Ariel Bardach, Luis Benejam, Mabel Berrueta, Marisú Bresca, Lidia Caballero, Carlos R. Cantale, Florencia Coronel, Roberto D´Angelo, Santiago Hasdeu, Guillermo Hugo de Hoyos, Humberto Jure, Karin Kopitowski, Luis Martin Landry, Esteban Langlois, Julián Gustavo Llera, Andrés Little, Jorge Lombardo, Ricardo A. Mackintosh, Lisandro Manfrin, Roxana Martinitto, Javier Pollan, Marcela Pose, Pedro Silberman Andrés Torn y Raúl Urquiza. Finally, they thank Dr Diana Pinto at the Inter American Development Bank for her advice and assistance with the project.

This study was funded by a contract from the Social Protection and Health Division of the Inter American Development Bank.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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