Trends in avoidable hospitalization rates in Italy, 2001-2008

Background: hospitalization for Ambulatory Care Sensitive Conditions (AC SC), also known\r\nas avoidable hospitalization (AH) has been proposed as effect measure of the accessibility and\r\neffectiveness of primary care. In the last years in developed countries, including Italy, hospitalization\r\nrates have decreased as well as the rates of AH. The decline of AH-rates could be just an effect of the\r\ngeneral trend of hospitalization. The objective of our study was to examine the adjusted trend of AH\r\nrates and to test possible associations with measures of primary care (re)organization.\r\nMethods: hospital discharges from 2001 to 2008 were analyzed. Main outcome measures were\r\nhospitalization rates, both as inpatient and day hospital. ACSCs were grouped in acute conditions,\r\npreventable through early diagnoses and treatment and chronic conditions, preventable through good\r\nongoing control and management. Expected time-series rates of AH, estimated on the hypothesis of\r\nsame time trends of Total Hospitalization (TH), were compared with observed ones using a Chi Square\r\ntest. Adjusted hospitalization rates were analyzed in conjunction with indicators of primary care.\r\nResults: in the studied period, in Italy, the TH rates declined with an average decrease of 19.6%,\r\nwhile the decrease for AH was 16.4%. The rates of AH adjusted for the trend of TH significantly\r\ndecreased only for chronic conditions. Decreasing trend of AH was correlated with the impact of\r\nreorganization of primary care in associative forms.\r\nConclusi onS: the presented methodology can be used to evaluate the real effectiveness of policies\r\naimed at reducing hospitalization for AC SCs.