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Hospitalizations for Ambulatory Care Sensitive Conditions and Quality of Primary Care: Their Relation With Socioeconomic and Health Care Variables in the Madrid Regional Health Service (Spain)

Magán, Purificación MD, PhD*†‡; Alberquilla, Ángel MD, PhD§; Otero, Ángel MD, PhD‡¶; Ribera, José Manuel MD, PhD‡‖

doi: 10.1097/MLR.0b013e3181ef9d13
Original Article

Background: Hospitalizations for ambulatory care sensitive conditions (ACSH) have been proposed as an indirect indicator of the effectiveness and quality of care provided by primary health care.

Objective: To investigate the association of ACSH rates with population socioeconomic factors and with characteristics of primary health care.

Research Design: Cross-sectional, ecologic study. Using hospital discharge data, ACSH were selected from the list of conditions validated for Spain.

Setting: All 34 health districts in the Region of Madrid, Spain.

Subjects: Individuals aged 65 years or older residing in the region of Madrid between 2001 and 2003, inclusive.

Measures: Age- and gender-adjusted ACSH rates in each health district.

Results: The adjusted ACSH rate per 1000 population was 35.37 in men and 20.45 in women. In the Poisson regression analysis, an inverse relation was seen between ACSH rates and the socioeconomic variables. Physician workload was the only health care variable with a statistically significant relation (rate ratio of 1.066 [95% CI; 1.041–1.091]). These results were similar in the analyses disaggregated by gender. In the multivariate analyses that included health care variables, none of the health care variables were statistically significant.

Conclusions: ACSH may be more closely related with socioeconomic variables than with characteristics of primary care activity. Therefore, other factors outside the health system must be considered to improve health outcomes in the population.

From the *Epidemiología Clínica-Unidad Investigación, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain; †CIBER Epidemiología y Salud Pública; ‡Red de Envejecimiento y Fragilidad (RETICEF); §Departamento de Sistemas de Información Sanitaria Gerencia Atensión Primaria Área 11, Madrid, Spain; ¶Departamento de Medicina Preventiva y Salud Pública (RETICEF) (IdiPAZ), Facultad de Medicina Universidad Autónoma, Madrid, Spain; and ‖Departamento de Gerontología y Geriatría, Facultad de Medicina, Universidad Complutense, Madrid, Spain.

Supported partially by the Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III (Spanish Ministry of Health) PI030767, PI051898, RD06/0013/1013, Fondo Europeo de Desarrollo Regional (FEDER).

All the authors meet each of the 3 authorship requirements as stated in the Uniform Requirements for manuscripts submitted to biomedical Journals.

Reprints: Purificación Magán Tapia, MD, PhD, Hospital Universitario 12 de Octubre, Edificio Materno-Infantil, Epidemiología Clínica, Unidad de investigación, Planta-2, Avda de Andalucía s/n, 28041 Madrid, Spain. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.