Ambulatory Care Sensitive Conditions (ACSC) 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.

Cause of Discharge/ER Visit

Causes are based on the principal diagnosis, except in cases where an External (E-code) cause supersedes the principal diagnosis. All discharges having external causes (injuries) are assigned their appropriate valid External Cause of Injury Code (E-Code) in accordance with STIPDA (State and Territorial Injury Prevention Directors Association) 2003 guidelines. The standards can be found at: http://www.safestates.org/.

Discharges/ER Visits

The number of inpatients discharged/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. Causes are based on the principal diagnosis, except in cases where an External (E-code) cause supersedes the principal diagnosis. 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, (ICD-10)

An alphanumeric coding scheme that replaces ICD-9, and used for discharge/er visit data since the 4^th quarter of 2015. ICD-10 codes were developed by the World Health Organization Collaborating Centres for Classification of Diseases.

Lifestages

An age year grouping methodology based upon predictable mortality. Georgia uses the following Lifestages: <1 Infancy, 1-4 Early Childhood, 5-12 Later Childhood, 13-19 Adolescence, 20-29 Early Adulthood, 30-44 Young Adulthood, 45-59 Middle Adulthood, 60-74 Late Adulthood, and 75+ Older Adulthood. The highest value for age is 120 years.

Non-Rural

Any county with 50,000 or more total population according to the United States decennial census of 2010 or any future such census (GA Code § 31-6-2 and 31-7-94.1).

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)
• 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.

Rural

Any county having a population of less than 50,000 according to the United States decennial census of 2010 or any future such census (GA Code § 31-6-2 and 31-7-94.1).

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.

V1.7 (1/4/2024)