Hospitalizations for Ambulatory Care Sensitive Conditions by Persons with Rheumatoid Arthritis: A Population-Based Study Using Administrative Data
Bibliographic record
Abstract
Objectives Ambulatory care sensitive conditions (ACSCs) are conditions where appropriate access to ambulatory care can reduce hospitalizations. People with rheumatoid arthritis (RA) are at higher risk for ACSC hospitalizations due to consequences of systemic inflammation and insufficient management of the condition in ambulatory practice. This project aims to estimate rates of avoidable hospitalizations by persons with RA relative to the general population. Methods We conducted a retrospective cohort study in Alberta, a province of ~4.6M, of individuals meeting a validated case definition for RA based on ICD codes in years 2002-2023. Controls were identified by matching age, sex, and date of diagnosis. There was a 5-year washout period to identify incident RA cases. We identified ACSCs using established ICD codes from the Canadian Institute for Health Information (including grand mal seizures, chronic lower respiratory diseases, asthma, diabetes, heart failure and pulmonary edema, hypertension, and angina). Incidence rate ratios (IRR) up to 5 years from the date of diagnosis were calculated using a multivariable regression model adjusting for age, sex, and location of residence. Results From a prevalent RA cohort composed of 52,596 individuals and 210,384 controls, there were 25,281 cases and 70,313 controls with hospitalizations during the study period. The number of hospitalizations was 83,811 in cases and 190,304 in controls, where 8.3% and 9.1% were for all ACSCs combined, respectively. Among cases, the highest frequency of ACSC hospitalizations was for chronic lower respiratory diseases at 3.8% (3202/83811). For all ACSCs combined, RA cases had a 14% higher risk of being hospitalized compared to the general population (IRR 1.14, 95% CI 1.08, 1.20). The risk of being hospitalized for heart failure and pulmonary edema was significantly higher among RA cases compared to those without RA (IRR 1.12, 95% 1.01, 1.25) (Table 1). Table 1. Crude and adjusted incidence rate ratios (95% CI) of ACSC hospitalizations . Conclusion Persons with RA are at a higher risk of avoidable hospitalizations in the first 5 years after diagnosis compared to those without RA. Improved ambulatory care access and quality, inclusive of primary care and subspecialty care, is needed to prevent unnecessary hospitalizations and reduce burden on the acute care system.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".