Ambulatory Care Sensitive Conditions (ACSC) Definitions

• Mapping Units
• Visible Layers
• Base Layers
• Definitions
• Map Tools

Presentation Information

• All numbers and rates pertain to the place of residence (not occurrence).
• If an Age group, Race, Sex, Ethnicity or Education Level are chosen, all rates/percentages include only the choices in both the numerator and denominator.
• Maps are used to emphasize the spatial distribution of one or more geographic attributes or variables. This site generates choropleth maps as thematic maps in which the geographies are shaded different colors to represent different magnitudes of a variable.
• The map projection is Lambert Conformal Conic.

Confidentiality rule:

Numbers based on 0-4 events are classified as a separate static class when a sub-county level geography (Census Tract or County Commission District) is chosen. This, in addition to offering only non-overlapping 5-year aggregates is done to assure confidentiality.

Not Reportable

At the County level or higher rates (and percents) based on 1-4 events are not reported due to statistical reliability reasons. At sub-county level (Census Tract or County Commission District), rates and percents based on 0-4 are not reported. This assures confidentiality.

Trendable Maps

Trendable maps are a series of choropleth maps showing change in spatial distribution of data in a selected area over selected period of time. Trendable maps share the same data class breaks which allows easy comparison between each map in the series.

Mapping Units:

• County to create a map of a selected geography: counties, Public Health District(s) or Perinatal Region(s); or
• Public Health District to create a map of the state by the 18 Public Health Districts; or
• Perinatal Region to create a map of the state by the 6 Perinatal Regions; or   
• County Commission District or Census Tract to create a map of a selected geography: counties, Public Health District(s) or Perinatal Region(s)

Visible Layers:

Census Tracts 2020

Census Tracts are small, relatively permanent statistical subdivisions of a county or equivalent entity that are updated by local participants prior to each decennial census.

Census tracts generally have a population size between 1,200 and 8,000 people.  A census tract usually covers a contiguous area; however, the spatial size of census tracts varies widely depending on the density of settlement.  Census tract boundaries are delineated with the intention of being maintained over a long time so that statistical comparisons can be made from census to census.  Census tracts occasionally are split due to population growth or merged as a result of substantial population decline.

Census tract boundaries generally follow visible and identifiable features.  They may follow nonvisible legal boundaries, such as minor civil division (MCD) or incorporated place boundaries in some states and situations, to allow for census-tract-to-governmental-unit relationships where the governmental boundaries tend to remain unchanged between censuses.  State and county boundaries always are census tract boundaries in the standard census geographic hierarchy. Reference Source: U.S. Commerce Department, United States Census Bureau, February 2022.

Cities/Towns

A mix of both incorporated places (legal entities) and census designated places or CDPs (statistical entities). An incorporated place is established to provide governmental functions for a concentration of people. Places always nest within a state, but may extend across county and county subdivision boundaries. An incorporated place usually is a city, town, village, or borough, but can have other legal descriptions. CDPs are delineated to provide data for settled concentrations of population that are identifiable by name, but are not legally incorporated under the laws of the state in which they are located. Click on city/town name to highlight the boundary. Reference Source: U.S. Census, 2020.

County Commission Districts

For more information, see http://www.accg.org/. The districts were established in 2014, and were obtained from the Association of County Commissioners of Georgia (ACCG). Further processing was performed by the Office of Health Indicators for Planning (OHIP) of the Georgia Department of Public Health. History and role: In 1868 the state began creating the position of county commissioner to administer the general operations of the county. Today every county has a commissioner; many have a board of commissioners (BOC). As part of general county operations, the BOC must finance county programs. A BOC has the power to adopt ordinances, resolutions, or regulations relating to county property, county affairs, and the operation of local government (http://www.georgiaencyclopedia.org/nge/Article.jsp?id=h-589 ).

GA House Districts

Electoral districts from which State Representatives are elected. The Georgia Constitution requires not less than 180 Representatives apportioned by population from representative districts. Layer Source: https://www.legis.ga.gov/, Adopted 2021 – Effective for 2022 Elections.

GA Senate Districts

Electoral districts from which State Senators are elected. The Georgia Constitution limits the number to not more than 56 single member districts. Senate districts are apportioned based on population. Layer Source: https://www.legis.ga.gov/, Adopted 2021 – Effective for 2022 Elections.

Hospitals

Hospitals are the non-Federal acute-care inpatient medical facilities in Georgia. Click on the symbol to get the name. Reference Source: Georgia Hospital Association, 2021.

Interstates

Interstates are the freeways that are part of the Interstate Highway System in Georgia. The Interstate Highway System connects major cities within the United States. Click on the line to get the Interstate number. Layer Source: Esri, March 1, 2012.

Major Roads

Major roads are a combination of both federal and state highways connecting cities and towns. Click on the line to get the route number. Layer Source: Esri, March 1, 2012.

Perinatal Regions

The Perinatal Regions were established by the Department of Public Health in cooperation with the six teaching hospitals located in Atlanta, Albany, Augusta, Columbus, Macon and Savannah. The Regions reflect the hospital referral patterns for high risk pregnant women and newborns Each of the six hospitals has a Regional Perinatal Center which has contracts with the state and receives funding to care for high risk pregnant women and infants as well as to train staff from other hospitals in perinatal care especially for high risk patients. Reference Source: Georgia Department of Public Health, March 2005.

ZIP Code

Established by the U.S. Postal Service for distribution of mail. Zip codes do not generally respect political boundaries or census areas such as tracts. Zip codes usually do not have clearly identifiable boundaries, often serve a continually changing area, are changed periodically to meet postal requirements, and do not cover all land area in the U.S. Layer Source: Esri, June 1, 2020.

Base Layers:

Base layers are background information to provide contextual references for local-level maps. They are especially suited for tract-level maps and give real-world reference to maps you create in OASIS. There are three toggle-able (on/off) base layers:

Demographic Clusters

Demographic Clusters refer to the socioeconomic status classifications created by OHIP, and are at the census block-group level. More information here: https://oasis.state.ga.us/gis/demographiccluster/DemoClusters2011.htm

Aerial Photography

Aerial Photography refers to ESRI's World Imagery.

Socioeconomic (SES) Vulnerability

Socioeconomic (SES) Vulnerability refers to the socioeconomic status domain/subset of the CDC’s Social Vulnerability Index (SVI) 2020. Socioeconomic vulnerability ranks census tracts within Georgia on 5 factors: below 150% poverty, unemployed, housing cost burden, no high school diploma, and no health insurance. Percentile ranking values range from 0 to 1, with higher values indicating greater vulnerability/lower socioeconomic status. Quintiles of the percentile rankings were used to create class breaks (Very Low, Low, Average, High and Very High SES Vulnerability). Keep in mind that “Very Low” SES Vulnerability equates to a High SES status. For more information see https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. For data dictionary click here.

Street Map

Street Map refers to ESRI's World Street Map with street-level data for North America.

Data Classification Methods:

Natural Breaks (Jenks)

This method minimizes within-class variance and maximizes between-class variance in an iterative series of calculations. This method seeks to partition data into classes based on natural groups in the data distribution. Natural breaks occur in the histogram at the low points of valleys. Breaks are assigned in the order of the size of the valleys, with the largest valley being assigned the first natural break.

George F. Jenks is considered a pioneer in GIS educational programs. Through an award from the Fund for Advancement of Science, Jenks identified four key objectives for cartographic training. Robert McMaster and Susanna McMaster; A History of Twentieth-Century American Academic Cartography

Source: Brewer and Pickle. Evaluation of Methods for Classifying Epidemiological Data on Choropleth Maps in a Series. Annals of the Association of American Geographers, 92(4), 2002, pp. 662-681.

Quantiles

• Data values for each enumeration unit (e.g. county or census tract) are ranked from lowest to highest.
• The total number of values is divided by the number of classes specified by the user to determine how many values each class will contain. The object is to obtain a roughly equal number of data values within each class. For example, if you have 100 census tracts and the tract data values are to be classed into 5 classes, each class will have 20 values (100/5 = 20).
• In some cases, an equal number of values will not be placed into each class. For instance, if there are an odd number of enumeration units some classes will have a larger number of data values than others. If data values for the 159 counties of Georgia are divided into 4 classes, then some classes might have 39 data values while others have 40. In addition, identical data values are maintained within the same classes. Continuing the Georgia county example, if 45 of the lowest data values are 0, then the lowest class will have 45 data values all with a value of 0.

The quantiles method of classification is provided because:

• Quantiles classification is one of the simplest methods of classification and is easy to understand and interpret.
• Classes are usually centered on the median, a measure of central tendency, and "they group enumeration units above and below the median into classes with equal frequencies regardless of their values." This makes maps easier to compare with one another.
• Many health-related measures are distributed normally (i.e. a large number of values falling near the middle of the data range with a smaller number of values on the low and high ends of the data range) making quantiles classification a logical classification method.

Source: Brewer and Pickle. Evaluation of Methods for Classifying Epidemiological Data on Choropleth Maps in a Series. Annals of the Association of American Geographers, 92(4), 2002, pp. 662-681.

Definitions:

Ambulatory Care Sensitive Conditions (ACSC)

Conditions that respond to timely and effective care in the outpatient (ambulatory) setting. ACSC's are used as Prevention Quality Indicators, and can assist in evaluating quality or use of primary health care.

Formula = [The number of ACSC's discharges (or ER visits) / The total number of discharges (or ER visits)] * 100

While primarily intended for application to hospital inpatient data, we have applied to ER Visit data as well.

Age

Ages are presented by Detailed Age Groups, Lifestages and Single Year of Age which is created by the Department of Public Health, OHIP. Also, note that selecting "all ages" will supercede any start and end age selection. Uncheck "all ages" to make an age-specific selection.

Data Classes

Also referred to as "class breaks" or groupings of data.

Discharges/ER Visits

The number of discharges/ER Visits from non-Federal acute-care inpatient facilities. Only discharges/ER Visits of Georgia residents who were seen in a Georgia facility are included. Persons can be counted more than once if readmitted. Discharges/ER visits include people both living and who have died. Discharges/ER Visits are reported by date of discharge, not admitting date.

Ethnicity

Hispanic or Latino includes persons of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. Non-Hispanic + Hispanic may not equal the total number of events due to persons of unknown ethnicity.

International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)

A statistical classification system, in use since 1979, that arranges diseases and injuries into groups according to established criteria. It is used to improve comparability of cause of death statistics reported by different governmental entities. Most ICD-9-CM codes are numeric and consist of three, four or five numbers and a description. The codes are revised approximately every 10 years by the World Health Organization and annual updates are published by the Health Care Financing Administration (HCFA), now the Center for Medicare, Medicaid Services.

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) vs. ICD10

The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification (CM) of the classification for morbidity (hospital and ER data) purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. ICD-10-CM is the replacement for ICD-9-CM, effective October 1, 2015 in discharge and ER data.

The ICD-10 is copyrighted by the World Health Organization (WHO). WHO has authorized the development of an adaptation of ICD-10 for use in the United States (ICD-10-CM). All modifications to the ICD-10 must conform to WHO conventions for the ICD. https://www.cdc.gov/nchs/icd/icd10cm.htm

Payor

Payor is the primary entity responsible for payment of services. Values for Payor include:

• Medicaid, based on Title XIX of the Social Security Act, is a Federal-State matching entitlement program that pays for medical assistance for certain vulnerable and needy individuals and families with low incomes and resources;
• PeachCare for Kids (Georgia's State Child Health Insurance Program (SCHIP)) is a program that provides comprehensive health care insurance for children through the age of 18 who do not qualify for Medicaid and live in households with incomes at or below the federal poverty level;
• Medicare is a health insurance program for people age 65 or older, some disabled people under age 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant);
• Private Insurance includes Blue Cross / Blue Shield, HMO/Managed Care, Commercial Insurance, Other non-specified Managed Care, PPO (Preferred Provider Organization), POS (Point of Service Provider),State Health Benefit Plan (SHBP); and
• Self Pay includes patients with no proof of insurance, patients filing their own insurance claims, patients paying their own bills, Hill-Burton cases, charity cases, etc.; and
• Other (All other plans) and Unknown Payor.

Percent ACSC Discharges/ER Visits

Formula = [The number of ACSC's discharges (or ER visits) / The total number of discharges (or ER visits)] * 100

Race

Per the Federal Office of Management and Budget, Directive 15 (1997),

• White is a person having origins in any of the original peoples of Europe, the Middle East or North Africa;
• Black or African-American is a person having origins in any of the black racial groups of Africa;
• Asian is a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam;
• American Indian/Alaska Native is a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment;
• Native Hawaiian or Other Pacific Islander is a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands;
• Multiracial is a person declaring 2 or more of these races.

Note: Rates for years prior to year 2000 use population estimates for the denominator that adhere to a different Federal standard for race: White, Black, Asian or Other Pacific Islander, American Indian and Alaska Native. So, unlike years 2000 and after, Multiracial is not included. Also, Asian by itself is not available because it was grouped with Pacific Islander (After 1999 Asian is separate from Native Hawaiian or Other Pacific Islander).

Rates using Census Population Estimates in the denominator are not calculated when a selected race is not available in the denominator, or zero.

Nevertheless, selections available in OASIS' Race query box reflect the 1997 Race classifications described above. Most of the numerators used in indicators in Oasis *do* have the year 2000 race selections. Therefore, selections of multiple years that span <2000 and 2000+ will return a *number (count)* for all race selections, but the *rates* may be limited by the change in racial classifications the federal government used as noted above. In these cases you will see NA₁ in the output cell (NA₁ therefore by definition will only show up in rates for the years before 2000).

In some cases, the numerator's race classification may be more precise, or up to date, than the Census population estimate counterpart used in the denominator. You may find that there are a number of births of a given race for a county/age-group selection, but no count of population estimated for the denominator. In such cases where the race selection was available for both the numerator and the denominator, but the denominator's estimate was zero, you will see a NA₂. If the numerator was greater than the denominator, but the denominator was > 0, you will see a NA₃ returned.

Socioeconomic (SES) Vulnerability

Socioeconomic (SES) Vulnerability refers to the socioeconomic status domain/subset of the CDC’s Social Vulnerability Index (SVI) 2020. Socioeconomic vulnerability ranks census tracts within Georgia on 5 factors: below 150% poverty, unemployed, housing cost burden, no high school diploma, and no health insurance. Percentile ranking values range from 0 to 1, with higher values indicating greater vulnerability/lower socioeconomic status. Quintiles of the percentile rankings were used to create class breaks (Very Low, Low, Average, High and Very High SES Vulnerability). Keep in mind that “Very Low” SES Vulnerability equates to a High SES status. For more information see https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. For data dictionary click here.

Map Tools

	Zoom In: Select this button and then click on the map to enlarge the map. You can also click down and drag your mouse to define an area to zoom to.
	Zoom Out: Select this button and the click on the map to reduce the map. The area where you click will be the center of the map. Note: Select the mouse scroll wheel to zoom in or out.
	Full Extent: Select this button to see the entire map.
	Pan: Select this button to move the map around in any given extent.
	Previous Extent: Click on this button to go back to the previous extent.
	Next Extent: Click on this button to go to the next extent (before previous extent)
	Print Map: Click on this button to get a printable copy of the map in PNG format as it appears at the moment. Disable any pop-up blockers. Right click on the preview and you can choose to save, copy or print the preview. The preview can also be dragged and dropped to a folder or desktop.

V1.16 (2/14/2024)