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Numerator

Number of hospitalizations for ambulatory care sensitive conditions by Medicare fee-for-service enrollees

Denominator

Number of Medicare fee-for-service enrollees

Methodology

Numerator counts are based on ICD-9-CM diagnosis codes. Conditions: Convulsions (780.3x): Chronic Obstructive Pulmonary Disease (COPD) (491xx, 492xx, 494xx, 496xx, 466.0x: 466.0x only w/secondary dx 491xx, 492xx, 494xx, 496xx): Bacterial Pneumonia (481xx, 482.2x, 482.3x, 482.9x, 483xx, 485xx, 486xx: excl. secondary dx 282.6x): Asthma (493xx): Congestive Heart Failure (CHF) (428xx, 402.01, 402.11, 402.91, 518.4x: excl. sx 36.01, 36.02, 36.05, 36.1x,37.5x, or 37.7x): Hypertension (401.0x, 401.9x, 402.00, 402.10, 402.90: excl. sx 36.01, 36.02, 36.05, 36.1x,37.5x, or 37.7x): Angina (411.1x, 411.8x, 413xx: excl. sx 01-86.99): Cellulitis (681xx, 682xx, 683xx, 686xx: excl. sx 01-86.99, unless 86.0x is the first and only sx code): Diabetes (250.0x, 250.1x, 250.2x, 250.3x, 250.8x, 250.9x): Gastroenteritis (558.9x): Kidney/Urinary Infection (590xx, 599.0x, 599.9x): Dehydration (276.5x).

Surgical codes are usually excluded to ensure that the admission was for a medical condition.

Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard.

References

Basu J, Friedman B, Burstin H. Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: A new approach. Med Care. 2002;40:1260-1269.

Ansari Z, Laditka JN, Laditka SB. Access to Health Care and hospitalization for ambulatory care sensitive conditions. Med Care Res Rev. 2006;63:719-741.