While many studies have focused on the hospitalization costs of hypertensive patients, few have examined avoidable hospitalization in hypertensive patients using big data.

This study aims to assess the prevalence of avoidable hospitalization among elderly hypertensive patients in Guangdong Province, providing insights for the integration and optimization of healthcare resources in the province's medical communities.

Health data for elderly individuals in Guangdong and hospitalization records from 2022 were integrated using the Guangdong Province Primary Healthcare Information Management System, the Guangdong Province Universal Health Information Platform, and inpatient case data. Influencing factors such as the number of general practitioners (GPs) per 10 000 population and the number of visits to primary healthcare institutions were obtained from the 2022 Guangdong Provincial Health Statistics Yearbook. A Logistic regression model was used to analyze the factors contributing to avoidable hospitalization.

The rate of avoidable hospitalization among elderly hypertensive patients in Guangdong Province was 8.76%. The likelihood of avoidable hospitalization was significantly higher in females [OR (95%CI) =1.231 (1.217-1.246) ] compared to males. Using 90 years and older as a reference, hypertensive patients aged 65-69, 70-74, 75-79, and 80-84 years were 2.044 [OR (95%CI) =2.044 (1.981-2.109) ], and 1.640 times more likely to avoid the occurrence of hospitalization than older hypertensive patients aged 90 years and older, respectively [OR (95%CI) =1.640 (1.590-1.693) ], 1.288 times [OR (95%CI) =1.288 (1.248-1.329) ], and 1.110 times [OR (95%CI) =1.110 (1.073-1.147) ]. Using a GDP per capita of less than 100 000 yuan as a reference, hypertensive patients with a GDP per capita of 100 000 yuan and above were 1.314 times more likely to have an avoidable incidence of hospitalization than those with a GDP per capita of less than 100 000 yuan [OR (95%CI) =1.314 (1.278-1.350) ]. When the number of GPs was ≥4 per 10 000 population, hypertensive patients were 1.039 times more likely to have avoidable hospitalization compared to those in areas with fewer than 4 GPs per 10 000 population [OR (95%CI) =1.039 (1.105-1.063) ]. The probability of avoidable hospitalization decreased by 40.60% when the number of secondary and tertiary hospitals per 10 000 population was less than 0.20 [OR (95%CI) =0.594 (0.570-0.619) ]. Finally, compared to areas with fewer than 3 visits per capita to secondary and tertiary hospitals or grassroots institutions, those with ≥3 visits per capita had a 1.047 times higher probability of avoidable hospitalization in secondary and tertiary hospitals [OR (95%CI) =1.047 (1.021-1.074) ], and a 1.229 times higher probability in grassroots institutions [OR (95%CI) =1.229 (1.191-1.268) ] .

Gender and age are significant factors influencing avoidable hospitalization in elderly hypertensive patients. Higher GDP per capita, greater visit frequency, and more GPs were associated with increased likelihood of avoidable hospitalization, while the number of secondary and tertiary hospitals did not contribute to this risk.

The accessibility and quality of ambulatory care (including outpatient and emergency services in primary care facilities, hospitals and other healthcare facilities) determine the efficiency of overall health care system and population health. Ambulatory care is also the core component of continuing care in an aging society. The concept of ambulatory care sensitive conditions (ACSCs) was firstly introduced by American researchers in 1990s. Since then, hospitalization for ambulatory care sensitive conditions (ACSHs) was widely used to evaluate the accessibility and quality of ambulatory care. In recent years, research on ACSH has gradually attracted the attention of scholars from all over the world, and preliminary research evidence from China indicated that the issue should not be ignored. This paper firstly introduces the origin of the concept of ACSH, then identifies the mixing concepts such as ACSH, avoidable hospitalization and inappropriate hospital admission, systematically summarizes the cutting-edge international identification criteria of ACSH, and finally discusses the policy value of ACSH as an indicator in the context of domestic and international research advances, clarifies the problems that should be noted in the identification of ACSCs in China, proposes strategies to reduce ACSH.

The issue of hospitalization for ambulatory care sensitive conditions (ACSH) is a significant problem worldwide, resulting in an annual waste of at least one hundred billion yuan in health resources in China. Implementing targeted interventions to reduce ACSH is an essential pathway towards sustainable health systems. It helps to reduce the occurrence and progression of diseases, improve public health levels, and reduce economic burdens. This study aims to systematically analyze the influencing factors of ACSH, summarize international experiences in reducing ACSH, and explore ACSH management strategies suitable for China's health system. ACSH are influenced by individual factors, health system factors, and social factors. Internationally, measures to reduce ACSH mainly focus on medical service models, service provision, and service management. Drawing on international experience and China's practical situation, this study proposes the following recommendations for managing ACSH in China: firstly, it is recommended to incorporate ACSH into the evaluation system of health services, comprehensively monitor and manage ambulatory care sensitive conditions (ACSCs) ; secondly, enhance health service capacity, promote the standardization and normalization of disease management based on evidence-based approach; moreover, conduct localized research on ACSH and promote the implementation of high-quality evidence; finally, continuously strengthen population health literacy, enhance patients' and the public's correct understanding of reducing ACSH.

Ambulatory care sensitive conditions (ACSCs) are illnesses that can be prevented from resulting in hospitalization with timely and effective ambulatory care. As the global emphasis on improving healthcare service quality and efficiency increases, understanding the evolution and research trends of ACSCs becomes increasingly vital.

To analyze the research hotspots, frontiers, and trends in the field of ACSCs over the past 30 years.

The English literature related to ACSCs published in the Web of Science was searched in March 2023. CiteSpace was utilized to perform a visualization analysis of the publication year, authors, research institutions, keywords and references extracted from the identified articles. The time frame was set from 1992 to 2023, with each time segment spanning five years. The network node correlation strength was determined using the "Cosine" algorithm. For the analysis, "Author" "Institution" and "Keyword" were selected as nodes, resulting in knowledge maps that illustrate co-occurrence among authors, institutions, and keywords.

From an initial pool of 1 701 articles, 1 698 were ultimately selected for analysis by CiteSpace. Research focusing on ACSCs had generally shown an upward trend in recent years. The top three prolific institutions were Harvard University [81 articles (4.77%) ], University of California [63 articles (3.71%) ] and University of Michigan [47 articles (2.77%) ]. Eight topic clusters were derived from keyword cluster mapping, namely "nursing home""public health""primary care""integrated care""impact""potentially avoidable hospitalizations""management", and "performance". Citation analysis showed that highly cited studies in this field focused on the status of avoidable hospitalizations, influencing factors, healthcare relationships, and reduction strategies.

Over the past 30 years, research in the field of ACSCs has rapidly progressed and is extensively utilized by major developed nations worldwide to evaluate and improve healthcare services. However, there is a lack of cross-regional collaboration among researchers and institutions, and research interests continually evolve. The main themes include the significance and policy implications of ACSCs and hospitalization for ambulatory care sensitive conditions (ACSH), influencing factors, practical applications, and policy insights. Domestic exploration of these crucial areas is insufficient and requires more attention in the future.