Resilience and health systems performance: admissions for ambulatory care-sensitive chronic conditions

Abstract Anchored in the concern to strengthen the resilience of the Unified Health System (SUS), this study aimed to develop a methodology for comparing Brazilian municipalities based on the standardized ratio of hospitalizations for chronic primary care-sensitive conditions (HPCSC). This cross-sectional study was based on data from the SUS hospital production. We adopted multilevel modeling for each Brazilian region. The ratio of observed to predicted hospitalizations, estimated by risk adjustment, was used to classify municipalities by level of occurrence of HPCSC (higher than expected, at the expected level, or lower than expected). The relationship between primary health care (PHC) coverage and HPCSC varied across Brazilian regions, with a lower percentage of municipalities with poorer performance in those with the highest availability of work hours of doctors and nurses. Due to its scope and role as a care coordinator in the healthcare network, PHC serves as the basis for building SUS resilience across various fields. Thus, the proposed methodology contributes to the continuous monitoring of PHC, an essential skill for resilience, enabling the timely guidance of actions and strategies in stress and crisis.