This document was published by the WHO Regional Office for Europe and explores means of measuring health system delivery performance. It sets out to review evidence related to ambulatory care sensitive condition hospitalizations (ACSHs) as a proxy indicator of health services delivery (HSD) performance. Based on ACSHs, this review identifies specific vantage points for HSD improvements. Explored concepts and evidence is further operationalized in a guide for country studies on ACSCs.
ACSCs are an example of acute, chronic, or vaccine-preventable conditions that can serve as markers for assessing HSD performance. Examples of ACSCs include chronic obstructive pulmonary disease (COPD), diabetes, asthma and angina, and can be described as those conditions where it is possible, to a large extent, to prevent acute exacerbations and reduce the need for hospitalizations through strong primary health care-based services delivery.
This work has set out to review the different approaches to measuring ACSCs set in the context of health systems-thinking to reason from outcomes to processes for performance improvement. Available evidence on the study of ACSHs as a performance indicator is first reviewed and then the potential of this measure to guide transformations for improving HSD performance is explored. Based on findings of the review, a self-assessment tool for use by countries to guide the study of HSD performance driven by a review of hospitalizations for priority ACSCs is provided.
