Insurance status and access to urgent ambulatory care follow-up appointments
Insurance status and access to urgent ambulatory care follow-up appointments
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DOI：
10.1001/jama.294.10.1248
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发表时间：
2005-09-14
影响因子：
120.7
通讯作者：
Kellermann, AL
中科院分区：
文献类型：
--
作者：
Asplin, BR;Rhodes, KV;Kellermann, AL
避免将可以作为门诊患者安全治疗的急诊科患者住院的压力越来越大，但这种策略取决于及时获得后续护理。目的确定报告的保险状况与急诊就诊中常见的严重疾病的随访预约之间的关系。8名研究助理（2002年5月至2003年2月）在美国9个城市随机选择499个门诊诊所，并确定自己是在急诊科见过的新患者，需要紧急随访预约（1周内）3个临床症状（肺炎、高血压或可能的异位妊娠）中的1个。同一个人给每个诊所打了两次电话，使用的是相同的临床小品，但保险状况不同。主要结果测量在一周内获得预约的来电者比例。结果在最终样本中联系的499家诊所中，430家完成了研究方案。在860个总来电者中，有460人（47.2%）和430个私人保险来电者中，有277人（64.4%）在一周内得到预约。声称拥有私人保险的来电者比声称拥有医疗补助的来电者更有可能接受预约(63.6% [147/231]vs 34.2%[79/231]；差异29.4个百分点；95%置信区间21.2-37.6，P
Context There is growing pressure to avoid hospitalizing emergency department patients who can be treated safely as outpatients, but this strategy depends on timely access to follow-up care.Objective To determine the association between reported insurance status and access to follow-up appointments for serious conditions that are commonly identified during an emergency department visit.Design, Setting, and Participants Eight research assistants called 499 randomly selected ambulatory clinics in 9 US cities (May 2002-February 2003) and identified themselves as new patients who had been seen in an emergency department and needed an urgent follow-up appointment (within 1 week) for 1 of 3 clinical vignettes (pneumonia, hypertension, or possible ectopic pregnancy). The same person called each clinic twice using the same clinical vignette but different insurance status.Main Outcome Measure Proportion of callers who were offered an appointment within a week.Results Of 499 clinics contacted in the final sample, 430 completed the study protocol. Four hundred six (47.2%) of 860 total callers and 277 (64.4%) of 430 privately insured callers were offered appointments within a week. Callers who claimed to have private insurance were more likely to receive appointments than those who claimed to have Medicaid coverage (63.6% [147/231] vs 34.2% [79/231]; difference, 29.4 percentage points; 95% confidence interval, 21.2-37.6, P