Table_1_The Characteristics and Outcomes of Patients Transported by Ambulance Due to Ambulatory Care Sensitive Condition: A Population-Based Descriptive Study in Osaka, Japan.xlsx

BackgroundAmbulatory care sensitive conditions (ACSCs) are defined as clinical conditions for which the risk of emergency hospital admission can be reduced by timely and effective ambulatory care. However, the actual status of patients with ACSCs who are transported by ambulance and their outcomes have not been fully elucidated. The purpose of this study was to reveal characteristics and outcomes of patients with ACSCs who were transported by ambulance using population-based registry data in Osaka, Japan.
MethodsThis descriptive epidemiological study was conducted in the 5-year period from January 2016 to December 2020, and included patients who were transported by ambulance due to sudden illness. In this study, ACSC was further classified into acute ACSCs, chronic ACSCs, and preventable ACSCs based on the ICD-10. The number of patients transported by ambulance for ACSCs per 100,000 population in each age group was calculated for each year. In addition, Poisson regression models were used to assess the trend in the number of ACSCs patients transported by ambulance.
ResultsA total of 1,572,152 patients were included in this study (acute ACSCs, n = 69,621; chronic ACSCs, n = 12,250; preventable ACSCs, n = 96,036; and non-ACSCs, n = 1,394,245). The overall median age was 71 years (95% confidence interval [CI], 46-92). Patients with acute ACSCs (median age: 76 years [IQR: 60-84]) and chronic ACSCs (median age: 80 years [IQR: 72-87]) were older, while patients with preventable ACSCs were younger (median age: 66 years [95%CI: 3-81]) and included a high proportion of children (33.3%, 32,002/96,036). Regarding the outcome after treatment at the emergency department, 42.6% (670,392/1,572.152) of patients were hospitalized, while 82.3% (10,079/12,250) of patients with chronic ACSCs were hospitalized. No change was observed in adults (P = 0.001) or elderly (age ≥65 years) individuals (P = 0.376) with preventable ACSCs, however, among children, the number increased until 2019 (732.5) and then decreased in 2020 (371.8) (P = 0.392).
ConclusionIn this study, patients with chronic ACSCs were predominantly elderly, while patients with preventable ACSCs were polarized between children and the elderly. Among patients with preventable ACSCs, there was no change over time in adults and children, but there was a marked decrease among the elderly after 2020.

研究背景
门诊医疗敏感病症（Ambulatory Care Sensitive Conditions, ACSCs）指可通过及时有效的门诊医疗降低急诊住院风险的临床病症。然而，因ACSCs就诊并被救护车转运的患者实际状况及其转归尚未完全阐明。本研究旨在利用日本大阪基于人群的登记数据，明确此类患者的特征与转归。

研究方法
本描述性流行病学研究的时间范围为2016年1月至2020年12月的5年周期，纳入因突发疾病被救护车转运的患者。本研究依据国际疾病分类第10版（ICD-10）将ACSCs进一步分为急性ACSCs、慢性ACSCs及可预防ACSCs。计算各年龄组每10万人口中每年因ACSCs被救护车转运的患者数量。此外，采用泊松回归模型评估ACSCs救护车转运患者数量的变化趋势。

研究结果
本研究共纳入1,572,152例患者（急性ACSCs：n=69,621；慢性ACSCs：n=12,250；可预防ACSCs：n=96,036；非ACSCs：n=1,394,245）。总体中位年龄为71岁（95%置信区间[CI]：46~92）。急性ACSCs患者（中位年龄：76岁，四分位距[IQR]：60~84）与慢性ACSCs患者（中位年龄：80岁，四分位距[IQR]：72~87）年龄偏高，而可预防ACSCs患者年龄偏低（中位年龄：66岁，95%置信区间[CI]：3~81），且儿童占比较高（33.3%，32,002/96,036）。在急诊室治疗后的转归方面，42.6%（670,392/1,572,152）的患者需住院治疗，其中慢性ACSCs患者的住院率达82.3%（10,079/12,250）。可预防ACSCs的成人（P=0.001）及老年（年龄≥65岁）患者（P=0.376）数量无明显变化，但儿童患者数量在2019年前呈上升趋势（732.5），2020年有所下降（371.8）（P=0.392）。

研究结论
本研究显示，慢性ACSCs患者以老年人为主，而可预防ACSCs患者呈现儿童与老年两极分化的特征。在可预防ACSCs患者中，成人与儿童患者数量随时间无明显变化，但老年患者数量在2020年后出现显著下降。