Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care–Sensitive Conditions

This article highlights the value of effective primary care in preventing hospitalizations and assessing what physicians attribute as causes of these potentially avoidable hospitalization. This article also sought to debunk the myth that the majority of hospitalizations can be prevented by primary care, a view that those in the medical field hold often, at least in the United States. Furthermore, the experiences of international researcher are useful in noticing patterns that may be applicable in the United States and other countries.

However, because each healthcare system is unique in its operation and its challenges, background of the German healthcare system would have illuminated the applicability of the study to other healthcare systems, such as that of the United States, where we will be future providers. This context is important to appropriately categorize high-risk patients in other healthcare systems, as factors that contribute to the categorization of ambulatory care-sensitive conditions are dependent upon the type of healthcare system. For example, the availability of after hours care in urgent care clinics in the United States differs significantly from the lack of after hours care in Germany as cited by the authors. The lack of information about costs, access, and obstacles in reaching continuity of care in Germany is also a detracting factor of this article.

Furthermore, because low risk patients are more likely to have a higher margin of prevention with fewer confounding factors than high-risk patients, identification and comparisons amongst low and moderate-risk patients along with high-risk patients may have served to increase predictive power. On the other hand, high-risk patients comprise a good patient population in which to identify areas where cost savings, quality of life, and quality of care can be greatly improved.

Additionally, the study design could have impacted the low rate of participation by the physicians (13% of invited practices participation). The lack of participation may have been impacted in part by some physicians feeling uncomfortable about reviewing their own charts for errors. Additionally, the extent of time and involvement required for the components of this study may also have greatly affected the sample size. Having physicians discuss cases that were not their own could have been a better approach to this study design. An interesting method would have been to have a group of physicians assess their own patients compared to physicians assessing patients that were not their own to remove any potential bias, but it would also take away from the personal information that the physician has regarding each patient's situation.

The word choice of "avoiding" versus potentially "delaying" hospitalizations is important to note. There may be some variability in what physicians define as patient level versus physician level factors. For example, medication error under patient level could be related to physician or pharmacist error or lack of education. Better explanation of many of these components would provide more depth to this article.

The limitations outlined in this study by the authors, such as the lack of input by the patients, were very much appreciated. The study also points to opportunities to improve assessment of patients' social situations and wider recognition of the various factors affecting patient care quality. This article served to increase awareness of our own roles in patient care and become more aware of how we as future providers can play a role in reducing avoidable hospitalizations, such as following up on the care of patients and emphasizing continuity of care, identifying high-risk patients in the medical record, focusing on targeted treatments for these patients, and emphasizing rapport building. As future providers in the United States, a replication of this study could further our understanding of what could best improve quality of healthcare for our patients.

Competing interests: ?? None declared