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The authors report on ambulatory care sensitive hospitalizations (ACSH)-admissions that might have been avoided by the timely provision of appropriate care outside the hospital (1, 2). To date, 19 disease entities have been identified that are relevant in the context of ACSH (3).

In this setting, certain criteria have to be met, such as relevantly high hospital admission rates, clear definition and coding of the diagnosis, potential avoidability of hospital admissions, and the necessity of the latter if symptoms occur. The authors see the advantage of ACSH over other quality indicators in the fact that the situation can be described on the basis of accounting data (“routine data”). Overall, the association between the analysed variables and the ACSH rates is weak. The authors suggest that in the future, aspects of the quality of medical services, comorbidities, and participation in healthcare programs should be taken into account.

When reading the article we noticed that the definition of ACSH relates exclusively todiseases of internal medicine.Cases of “ambulatory care sensitive hospitalization” from surgery were not considered. This would be particularly interesting for patients who have had major surgery, who, after discharge from inpatient treatment, cannot be sufficiently provided with outpatient care and who therefore often have to be readmitted to the hospital (the so called “revolving door” effect). In vascular surgery, this affects primarily diabetic patients with impaired arterial perfusion of the legs, who, in order to avoid major amputations had bypass surgery in combination with minor amputations on the feet. Their readmission rate is up to 30% after seven weeks (4). This hints at problems in outpatient care provision, such as insufficient interdisciplinary networking. Successful alternative approaches to provide care for patients with diabetic foot syndrome already exist (4).

Perhaps the authors see an opportunity to expand their elaborate data collection system to such cases? Would it not be useful to include the term “re-hospitalization”, so as to tackle the problems of intersectoral, interdisciplinary, and, last but not least, interprofessional communication?

DOI: 10.3238/arztebl.2014.0600a

Prof. Dr. med. Gerhard Rümenapf

Klinik für Gefäßchirurgie,
Diakonissen-Stiftungs-Krankenhaus Speyer

Mannheim

n.u.g.ruemenapf@t-online.de

Dr. med. Stephan Morbach

Marienkrankenhaus Soest

Dr. rer. nat. Johannes Boettrich

Sandra Geiger

Dr. rer. nat. Norbert Nagel

Medical Scientific Affairs,
B.Braun Melsungen AG,
Melsungen

1.
Burgdorf F, Sundmacher L: Potentially avoidable hospital admissions in Germany—an analysis of factors influencing rates of ambulatory care sensitive hospitalizations. Dtsch Arztebl Int 2014; 111: 215–23 VOLLTEXT
2.
Agency for Healthcare, Research and Quality: AHRQ quality indicators – guide to prevention quality indicators: hospital admission for ambulatory care sensitive conditions. Revision 3. Rockeville MD:AHRQ 2004; pub. Nr. 02-R0203. www.ahrq.gov/download/pub/ahrqqi/pqiguide.pdf. Last accessed on 10 May 2014.
3.
Purdy S, Griffin T, Salisbury C, Sharp D: Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health 2009; 123: 169–73 CrossRef MEDLINE
4.
Rümenapf G, Geiger S, Schneider B, et al.: Readmissions of patients with Diabetes and foot ulcers after infra-popliteal bypass surgery: attacking the problem by an integrated case management model. Vasa (Eur J Vasc Med) 2013; 42: 56–67 CrossRef MEDLINE
1.Burgdorf F, Sundmacher L: Potentially avoidable hospital admissions in Germany—an analysis of factors influencing rates of ambulatory care sensitive hospitalizations. Dtsch Arztebl Int 2014; 111: 215–23 VOLLTEXT
2.Agency for Healthcare, Research and Quality: AHRQ quality indicators – guide to prevention quality indicators: hospital admission for ambulatory care sensitive conditions. Revision 3. Rockeville MD:AHRQ 2004; pub. Nr. 02-R0203. www.ahrq.gov/download/pub/ahrqqi/pqiguide.pdf. Last accessed on 10 May 2014.
3.Purdy S, Griffin T, Salisbury C, Sharp D: Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health 2009; 123: 169–73 CrossRef MEDLINE
4.Rümenapf G, Geiger S, Schneider B, et al.: Readmissions of patients with Diabetes and foot ulcers after infra-popliteal bypass surgery: attacking the problem by an integrated case management model. Vasa (Eur J Vasc Med) 2013; 42: 56–67 CrossRef MEDLINE

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