Wide variation in potentially preventable hospitalizations for chronic conditions across Canada: CIHI

May 29, 2008 – Hospitalization rates vary across the country for seven chronic conditions that could potentially be managed or treated in the community, known as ambulatory care sensitive conditions (ACSC). A new report from the Canadian Institute for Health Information (CIHI) and Statistics Canada measures ACSC admission rates in health regions across Canada and explores the factors that contribute to higher or lower rates. ACSC are conditions, such as asthma, diabetes and hypertension, where appropriate primary health care in the community may prevent or reduce the need for hospital admission.

“This indicator is important for health planners,” says Glenda Yeates, President and CEO of CIHI. “Hospital stays can be disruptive for patients and costly for the health system as a whole. While hospitalizations for ambulatory care sensitive conditions are not always avoidable, higher rates of admission may signal an opportunity to improve the planning or delivery of primary health care services to better meet the needs of the population.”

CIHI’s annual report, Health Indicators 2008, produced with Statistics Canada, provides more than 40 measures of health and health system performance, including a special focus section on ACSC hospitalization rates. In 2006–2007, there were about 87,500 admissions to Canadian hospitals, outside Quebec, for ambulatory care sensitive conditions.

Regional variation in ACSC hospitalization rates

Health Indicators 2008 highlights differences in ACSC hospitalization rates between provinces and territories and between regions. In 2006–2007, outside Quebec, rates varied four-fold across the provinces and territories and five-fold across individual health regions, after adjusting for differences in the age of the population. There were also significant differences between urban and rural areas over this same time period. ACSC hospitalization rates were 60% higher in rural areas (510 per 100,000 population) than in urban areas (318 per 100,000 population).

“There are several factors that may help explain these variations,” says Indra Pulcins, Director of Health Reports and Analysis at CIHI. “Communities reporting problems with access to primary health care, such as a low physician supply, may have higher admission rates for ambulatory care sensitive conditions. The ability to manage these conditions in the community, such as getting the right tests for diagnosis and the right medications, as well as appropriate patient self-monitoring, may also play a role. This indicator offers health planners an important first step toward identifying potential factors in order to target improvement efforts for specific regions.”

Canadians living in lower-income neighbourhoods more likely to be hospitalized for ACSC

ACSC rates also varied by neighbourhood income. In 2006–2007, the hospitalization rate for those younger than 75 years of age with an ACSC in Canada’s lowest-income neighbourhoods (521 per 100,000 population) was more than twice as high as the rate in the highest-income neighbourhoods (234 per 100,000 population), outside Quebec.

“Our study confirms there is a significant gap between Canadians living in richer and poorer neighbourhoods when it comes to potentially preventable hospitalizations for chronic diseases,” says Greg Webster, CIHI’s Director of Research and Indicator Development. “The higher your neighbourhood income, the less likely you are to be admitted to hospital for an ambulatory care sensitive condition.”

ACSC hospitalization rates decline over five years

Overall, ACSC hospitalization rates in Canada, outside Quebec, decreased by 22% between 2001–2002 and 2006–2007, after population growth and aging were taken into account.This decline is more than one and a half times greater than the 14% drop observed for all medical hospitalizations over the same period.

Among the provinces and territories, the largest decreases in rates were seen in Nova Scotia (28%) and Ontario (26%).

“While the burden of chronic disease is on the rise in Canada and around the world, the good news is that, overall, hospitalization rates are falling for ambulatory care sensitive conditions,”says Webster.

1 in 5 patients readmitted for an ACSC within one year of admission

CIHI’s analysis also shows that return visits to the hospital are common for ACSC patients.In 2005–2006, there were close to 75,000 patients hospitalized, outside Quebec, for an ACSC.About 20% of these patients, or 1 in 5, were readmitted to hospital at least once for the same or another ACSC within one year of their admission.

Other highlights from Health Indicators 2008

Health Indicators 2008 is the ninth report in a series of annual reports, providing the most recent health indicator data from CIHI and Statistics Canada. The comparable data in this report on the health of Canadians, on community and health system characteristics, as well as on the performance of the health system, are used by health regions and others to track progress on health status and health system performance and to compare results across the country. The following are just a few of the significant findings from the new health indicators results:

  • Injury hospitalization rates continue to fall in most of the provinces and territories. As a result, the Canadian rate decreased from 589 per 100,000 population (in 2001–2002) to 543 (in 2005–2006)—an 8% decrease after population growth and aging were taken into account.
  • There are two-fold or larger differences from region to region for most of the reported health indicators. For example, across the country the combined rate of two cardiac revascularization procedures (angioplasty and cardiac bypass surgery) in 2006–2007 was 251 per 100,000 population, outside Quebec. Rates for larger health regions ranged from 166 to 393 per 100,000 population.
  • Overall, the readmission rate after heart attack, outside Quebec, decreased from 6.2% (for the period 2003–2004 to 2005–2006) to 5.6% (for the period 2004–2005 to 2006–2007), whereas readmission rates after asthma, hysterectomy and prostatectomy remained unchanged.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca