Ambulatory Care Sensitive Admissions Tip Sheet

Cov nyiaj pab txhawb nqa raug them rau tus kws kho mob thawj zaug (PCP) txhua xyoo, tom qab xaus rau lub quarter thib plaub. Yog xav paub ntxiv, mus saib CBI Technical Specifications.

• Cov tswv cuab ntawm pawg thawj coj thaum kawg ntawm lub sijhawm ntsuas.
• Cov tswv cuab ob tog.
• California Children’s Services (CCS) members.
• Condition-specific as outlined by the AHRQ.

The ambulatory care sensitive conditions listed below are derived from the Prevention Quality Indicators in Inpatient Settings Measures (PQIs) thiab Pediatric Quality Indicator Measures (PDIs) criteria released by the Agency for Health Care Research and Quality (AHRQ). The list of diagnoses for the measure includes:

• Asthma nyob rau hauv cov neeg laus.
• Cov zej zog kis mob ntsws.
• COPD/asthma in older adults (>40 years old).
• Mob ntshav qab zib muaj teeb meem ntev.
• Mob ntshav qab zib muaj teeb meem luv luv.
• Lub plawv tsis ua hauj lwm.
• Ntshav siab.
• Lower extremity amputation with diabetes.
• Pediatric mob hawb pob.
• Pediatric gastroenteritis.
• Pediatric short-term diabetes.
• Pediatric urinary tract infection.
• Kev tswj tsis tau ntshav qab zib.
• Kab mob urinary ib ntsuj av.

Data for this measure is collected using claims.

• Educate all members to:
  • Siv Alliance kev kawm txog kev noj qab haus huv thiab cov kev pab cuam kho mob rau tus kheej to help them achieve healthier outcomes:
    • Healthier Living Program (HLP) workshop – Chronic Conditions.
    • Live Better with Diabetes (LBD) program – Diabetes/Prediabetes.
    • Weight Watchers program – Adult Weight Management.
    • Healthy Weight for Life (HWL) program workshops – Children ages two to 18
    • Healthy Moms and Healthy Babies (HMHB) program – Early prenatal and postpartum care
    • Tobacco Cessation Support Program (TCSP) – Quitting Tobacco.
  • Understand and manage their conditions through health education resources.
    • Asthma Action Plans – Regional Asthma Management & Prevention (RAMP).
    • My COPD Action Plan – American Lung Association:
      • Askiv
      • Mev
    • Steps to Help You Stay Healthy with Diabetes - Cov Chaw Tswj thiab Tiv Thaiv Kab Mob.
  • Siv Ask Me 3: Good Questions for Your Good Health thaum mus ntsib to encourage them to ask three specific questions to better understand their health conditions and what they need to do to stay healthy:
    • Kuv qhov teeb meem loj yog dab tsi?
    • Kuv yuav tsum ua dab tsi?
    • Vim li cas nws thiaj li tseem ceeb rau kuv ua qhov no?
  • Discover how to Get Ahead of Sepsis.
• Assign clinical staff to:
  • Identify members at high risk for hospitalization and provide:
    • Regular medication reviews (what medication is taken and how?).
    • Regular monitoring of symptoms and treatment adherence in high-risk patients.
    • Self-management training and caregivers to help identify when to manage acute deterioration or when to seek timely care from the PCP.
    • Assistance using the Daim ntawv xa mus rau Cov Kev Pabcuam Kev Noj Qab Haus Huv rau kev tswj kab mob thiab kev kawm txog kev noj qab haus huv. Yog muaj lus nug, thov hu rau Alliance Health Education Line ntawm 800-700-3874, ib. 5580 ua.

• Provide members information on your office hours, how to reach you after hours, and what conditions you will see urgently.
  • Heart failure, COPD/asthma in older adults, bacterial pneumonia and urinary tract infections continue to be the top diagnoses for ambulatory care sensitive conditions.
• Saib xyuas lub Provider Portal Linked Members Inpatient Admissions report to track linked members who are admitted to the hospital or were discharged based on eCensus data.
• Contact and schedule members that were discharged los ntawm tsev kho mob mus ntsib lawv tus PCP hauv 14 hnub.
• Review discharge instructions to ensure members understand their post-care and have assistance at home during their recovery time.

• Kev Pabcuam Kab Lis Kev Cai thiab Lus ntawm Alliance muaj rau cov neeg muab kev pabcuam hauv network.
  • Cov Kev Pab Txog Lus - Thov cov ntaub ntawv ntawm 800-700-3874, ext. 5504.
  • Kev Pab Txhais Lus Hauv Xov Tooj - Hu ncaj qha rau tus neeg txhais lus hauv xov tooj 24 teev hauv ib hnub, 7 hnub hauv ib lub lim tiam.
  • Kev Pab Txhais Lus - Thov tau rau lub sijhawm teem tseg nrog tus tswv cuab.
  • Kev Pabcuam Txhais Lus Nyob Deb (VRI) - Thaum tus neeg txhais lus ntawm tus kheej tsis muaj lossis tsis yooj yim rau kev nkag mus.
  • Yog xav paub ntxiv txog Kev Pabcuam Kab Lis Kev Cai thiab Kev Kawm Lus, hu rau Alliance Health Education Line ntawm 800-700-3874, ext. 5580 lossis email rau peb ntawm [email protected].
• Kev Tswj Xyuas Kev Kho Mob Zoo Dua ntawm Lub Koom Haum (ECM) thiab Kev Txhawb Nqa Hauv Zej Zog.
  • Xa cov tswv cuab ntawm Alliance los ntawm Alliance Provider Portal, email [email protected], xa ntawv los yog fax, los yog hu xov tooj ntawm 831-430-5512.
  • Yog xav tau Kev Tswj Xyuas Kev Kho Mob Nyuaj thiab Kev Sib Koom Tes Saib Xyuas, hu rau pab pawg Saib Xyuas Kev Kho Mob ntawm 800-700-3874 (TTY: Hu 711).
• Alliance Tus Xov Tooj Nug Kev Pab Los Ntawm Tus Kws Tu Neeg Mob (Nurse Advice Line) mus tham nrog ib tug nais maum.
  • 844-971-8907 (TTY: Hu rau 711).
  • Qhia txhua tus tswv cuab kom siv Alliance Nurse Advice Line uas muaj rau txhua tus tswv cuab ntawm Alliance 24 teev hauv ib hnub, 7 hnub hauv ib lub lim tiam los tham txog kev txhawj xeeb txog kev noj qab haus huv kom tsis txhob rov qab mus pw hauv tsev kho mob thiab kev mus ntsib kws kho mob thaum muaj xwm txheej ceev uas tiv thaiv tau.
  • Ntxiv rau koj tsob ntoo xov tooj thiab xa cov xov tooj tom qab lub sijhawm ua haujlwm los ntawm cov tswv cuab ntawm Alliance.

• Kev Pabcuam Thauj Mus Los ntawm Alliance rau cov neeg mob uas muaj teeb meem kev thauj mus los.
  • Yog xav tau kev pab thauj neeg mob uas tsis yog xwm txheej ceev (NEMT), hu rau 800-700-3874, ext. 5640 (TTY: Hu 711).
  • Yog xav tau kev pab thauj mus los uas tsis yog kev kho mob (NMT), hu rau 800-700-3874, ext. 5577 (TTY: Hu 711).
• Behavioral Health Primary Care Provider (PCP) Referral Form.
• Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions.