Abstract
Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations for ACSCs. Participants included 33,273 male Veterans Affairs general medicine outpatients who returned mailed surveys. The main outcome was hospitalization with a primary discharge diagnosis for an ACSC in the year following screening. Analyses were adjusted for demographics, comorbidity, and other health behaviors. Current and previous smoking and abstaining from alcohol were associated with significantly increased risk of hospitalization for ACSCs, but alcohol misuse was not. However, severe alcohol misuse was associated with increased risk of hospitalizations with a primary or secondary ACSC discharge diagnosis. When ACSCs are used to evaluate the quality of care, health systems caring for populations with higher rates of smoking or nondrinking could falsely appear to have poorer quality care if alcohol and tobacco use are not considered.
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Acknowledgments
The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HSR&D) Grant IIR (#IAC 05-206-1); Dr. Chew was a Fellow with the VA Puget Sound HSR&D at the time this research was begun. Dr. Bryson was supported by a VA Career Development Award (RCD03-177). Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Washington. The authors acknowledge Emily C. Williams, PhD, MPH and Madeleine S. Frey for help in manuscript preparation.
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Chew, R.B., Bryson, C.L., Au, D.H. et al. Are Smoking and Alcohol Misuse Associated with Subsequent Hospitalizations for Ambulatory Care Sensitive Conditions?. J Behav Health Serv Res 38, 3–15 (2011). https://doi.org/10.1007/s11414-010-9215-x
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DOI: https://doi.org/10.1007/s11414-010-9215-x