Spatial access to health care and elderly ambulatory care sensitive hospitalizations

Objectives: Ambulatory care sensitive condition (ACSC) admission rates have been widely used as indicators of access to and quality of primary care as well as the efficiency of health systems. This study examines associations of spatial access to health care with both inpatient hospital admissions and emergency department (ED) visits for ACSCs for older adults. This study also compares inpatient hospitalization admissions and ED visits for elderly ACSCs by spatial access to health care. Study design: This is a complete hospital discharge dataset study. Methods: Hospital discharge data were obtained from all hospital systems in the Coastal Bend area of Texas from September 1, 2009, to August 31, 2012. The enhanced two-step floating catchment area method was adopted to measure spatial access to health care, including primary health care and hospitals. Multivariable regression methods were used to measure the associations between spatial access to health care and ACSC rates of both inpatient hospitalizations and ED visits. Results: Spatial access to primary care has a statistically significant positive relationship with both rates of inpatient hospitalization admissions and ED visits for ACSCs for the elderly. Spatial access to hospitals has a statistically significant negative relationship with both rates. Spatial access to primary care has a significantly negative contribution to the likelihood of inpatient hospitalizations compared with the likelihood of ED visits for elderly ACSCs, whereas spatial access to hospitals has a significantly positive contribution. Conclusions: Spatial access to health care contributes to elderly ACSC hospitalizations. A poorer access to primary care or a better access to hospitals increases both rates of inpatient hospitalizations and ED visits for elderly ACSCs. Seniors living in areas where residents had poor access to primary care or easy access to hospitals were more likely to visit EDs instead of being inpatients for ACSC conditions. Policy action is needed to improve spatial access to primary care for the elderly. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.