Skip to main content
The central role of comorbidity in predicting ambulatory care sensitive hospitalizations
Meyers Primary Care Institute Publications and Presentations
  • Barry G. Saver, University of Massachusetts Medical School
  • Ching-Yun Wang, Fred Hutchinson Cancer Research Center
  • Sharon A. Dobie, University of Washington School of Medicine
  • Pamela K. Green, University of Washington School of Medicine
  • Laura-Mae Baldwin, University of Washington School of Medicine
UMMS Affiliation
Meyers Primary Care Institute; Department of Family Medicine and Community Health
Publication Date
Document Type
Ambulatory Care; Hospitalization; Comorbidity
BACKGROUND: Ambulatory care sensitive hospitalizations (ACSHs) are commonly used as measures of access to and quality of care. They are defined as hospitalizations for certain acute and chronic conditions; yet, they are most commonly used in analyses comparing different groups without adjustment for individual-level comorbidity. We present an exploration of their roles in predicting ACSHs for acute and chronic conditions. METHODS: Using 1998-99 US Medicare claims for 1 06 930 SEER-Medicare control subjects and 1999 Area Resource File data, we modelled occurrence of acute and chronic ACSHs with logistic regression, examining effects of different predictors on model discriminatory power. RESULTS: Flags for the presence of a few comorbid conditions-congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and, for acute ACSHs, dementia-contributed virtually all of the discriminative ability for predicting ACSHs. C-statistics were up to 0.96 for models predicting chronic ACSHs and up to 0.87 for predicting acute ACSHs. C-statistics for models lacking comorbidity flags were lower, at best 0.73, for both acute and chronic ACSHs. CONCLUSION: Comorbidity is far more important in predicting ACSH risk than any other factor, both for acute and chronic ACSHs. Imputations about quality and access should not be made from analyses that do not control for presence of important comorbid conditions. Acute and chronic ACSHs differ enough that they should be modelled separately. Unaggregated models restricted to persons with the relevant diagnoses are most appropriate for chronic ACSHs.
DOI of Published Version

Eur J Public Health. 2013 Mar 28. Link to article on publisher's site

Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Barry G. Saver, Ching-Yun Wang, Sharon A. Dobie, Pamela K. Green, et al.. "The central role of comorbidity in predicting ambulatory care sensitive hospitalizations" (2013) ISSN: 1101-1262 (Linking)
Available at: