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Ambulatory Care Sensitive Conditions

 

To qualify under this metric, patients must be:

  • An Ontario resident
  • Less than 75 years of age
  • Hospitalized in an acute care hospital
  • Assigned specific ICD-10 codes, as follows:

Group A (includes these conditions)

  • Grand mal status and other epileptic convulsions (codes beginning with G40 or G41)
  • Chronic obstructive pulmonary disease (codes beginning with J41, J42, J43, J44, J47)
  • Asthma (codes beginning with J45)
  • Congestive heart failure and pulmonary edema (codes beginning with I50 or J81 excluding cases with cardiac procedures that are not codes as “abandoned after onset”)
  • Hypertension (codes beginning with I10.0, I10.1, I11 excluding cases with cardiac procedures that are not codes as “abandoned after onset”)
  • Angina (codes beginning with I20, I23,82, I24.0, I24.8, I24.9 excluding cases with cardiac procedures that are not codes as “abandoned after onset”)
  • Diabetes (codes beginning with E10.0, E10.1, E10.63, E10.9, E11.0, E11.1, E11.63, E11.9, E13.0, E13.1, E13.63, E13.9, E14.0, E14.1,E14.63, E14.9, E10.64, E11.64, E13.64, E14.64)

Group B (includes these conditions)

  • Lower respiratory (Codes beginning with J10.0, J11.0, J12, J13, J14, J15, J16, J20, J21, J22 ONLY when a secondary diagnoses is also present)

Group C (excludes these conditions)

  • MRDx of CHF, hypertension, or angina (Codes beginning with 1HA58, 1HA80, 1HA87, 1HB53, 1HB54, 1HB55, 1HB87, 1HD53, 1HD54, 1HD55, 1HH59, 1HH71, 1HJ76, 1HJ82, 1HM57, 1HM78, 1HM80, 1HN71, 1HN80, 1HN87, 1HP76, 1HP78, 1HP80, 1HP82, 1HP83, 1HP87, 1HR71, 1HR80, 1HR84, 1HR87, 1HS80, 1HS90, 1HT80, 1HT89, 1HT90, 1HU80, 1HU90, 1HV80, 1HV90, 1HW78, 1HW79, 1HX71, 1HX78, 1HX79, 1HX80, 1HX83, 1HX86, 1HX87, 1HY85, 1HZ53, 1HZ54, 1HZ55, 1HZ56, 1HZ57, 1HZ59, 1HZ80, 1HZ85, 1HZ87, 1IF83, 1IJ50, 1IJ55, 1IJ57, 1IJ76, 1IJ80, 1IK57, 1IK80, 1IK87, 1IN84, 1LA84, 1LC84, 1LD84, 1IJ86)
Visits Manageable Elsewhere

 

Visits are manageable elsewhere when the following criterion are met:

  • Unscheduled visits to an emergency room not resulting in an inpatient admission
  • CTAS levels 4 and 5
  • Between 1 and 75 years of age
  • an Ontario resident
  • Having the following ICD-10 codes: A740, B309, H100, H101, H102, H103, H104, H105, H108, H109, H130, H131, H132, H133, N300, N301, N302, N303, N304, N308, N309, N330, N390, H650, H651, H652, H653, H654, H659, H660, H661, H662, H663, H664, H669, H670, H671, H678, J00, J010, J011, J012, J013, J014, J018, J019, J028, J029, J038, J039, J040, J041, J060, J068, J069, J310, J311, J312, J320, J321, J322, J323, J324, J328, J329, J350, J351, J352, J353, J358, J359, J399