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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.

Background 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. Objective To analyze the research hotspots, frontiers, and trends in the field of ACSCs over the past 30 years. Methods 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. Results 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. Conclusion 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.

BackgroundNarrative exposure therapy （NET）， an integration of narrative therapy and exposure therapy， has been shown to be effective in relieving the symptoms of post-traumatic stress disorder （PTSD）， which can help patients gain a deeper understanding of their trauma and is also considered to be quite safe. PTSD is highly prevalent in children and adolescents， while the effectiveness of NET intervention varies among the subjects.ObjectiveTo systematically evaluate the effectiveness of NET for PTSD in children and adolescents， so as to provide references for the clinical application of NET.MethodsOn August 1， 2022， the Cochrane Library， PubMed， Web of Science， CINAHL， China National Knowledge Infrastructure （CNKI）， SinoMed， VIP and Wanfang database were searched from their inception to June 2022. Search was conducted with the use of a combination of medical subject heading and free text terms， and randomized controlled trials relevant to NET for PTSD in children and adolescents were collected. Then the quality of the controlled trials was evaluated according to the Cochrane Collaboration's tool for assessing risk of bias （2011）， and Meta-analysis was performed using RevMan 5.4 software.ResultsNine randomized controlled trials involving 394 children and adolescents with PTSD were included. Meta-analysis showed that NET and relaxation therapy reported comparable symptom relief in PTSD patients within 1 to 3 months after intervention （SMD=0.22， 95% CI： -0.84~1.28） and at 6 months after intervention （SMD=0.21， 95% CI： -0.75~1.17）， while NET provided greater PTSD symptom relief than routine therapy both within 1 to 3 months after intervention （SMD=-0.66， 95% CI： -1.04~-0.27） and at 6 months after intervention （SMD=-0.77， 95% CI： -1.36~-0.19）， with statistically significant differences. Regarding the alleviation of depressive symptoms， the effect was similar between NET and routine therapy within 1 to 3 months after intervention （SMD=-0.39， 95% CI： -0.98~0.21） and at 6 months after intervention （SMD=-0.74， 95% CI： -2.23~0.75）. No statistical difference was demonstrated between NET and routine therapy in relieving psychological distress （SMD=-0.54， 95% CI： -2.14~1.07） and suppressing hyperorexia （SMD=-0.17， 95% CI： -0.54~0.19） 1 to 3 months after intervention.ConclusionNET yields a better outcome and a medium- and long-term effectiveness in alleviating symptoms of PTSD in children and adolescents compared with routine therapy， while it does not offer any significant advantages in improving depression symptoms， psychological distress and hyperorexia.