Trends and Characteristics of US Emergency Department Visits, 1997-2007
Trends and Characteristics of US Emergency Department Visits, 1997-2007
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DOI：
10.1001/jama.2010.1112
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发表时间：
2010-08-11
影响因子：
120.7
通讯作者：
Gonzales, Ralph
中科院分区：
文献类型：
--
作者：
Tang, Ning;Stein, John;Gonzales, Ralph
背景美国急诊科（ED）的未保险和保险不足的人数增加的潜在影响是一个关注的卫生保健safety net.Objective描述的变化，艾德访问发生在1997年至2007年在美国成人和儿童人口的社会人口学组，指定的安全网艾德，并在动态护理敏感条件的趋势。从1997年到2007年的国家医院门诊医疗调查（NHAMCS）中公开的艾德就诊数据按年龄、性别、种族、民族、保险状况、安全网医院分类、分诊类别和处置进行分层。使用国际疾病分类第九次修订版（ICD-9）中的代码提取与门诊护理敏感条件相关的访视。主要结果测量美国ED的年总就诊率和人口亚组的艾德就诊率。结果1997年至2007年，艾德就诊率从每1000人35.8人增加到390.5人（率差，37.7; 95%置信区间[Cl]，-51.1至126.5;趋势P= 0.001）;总的年度艾德访视的增加几乎是人口增长预期的两倍。接受医疗补助的成年人占艾德就诊人数增加的大部分; 1999年至2007年期间，每1000名登记者的就诊率从693.9增加到947.2（率差，253.3; 95% CI，41.1至465.5;趋势P= 0.001）。虽然患有门诊护理敏感性疾病的成人的艾德就诊率保持稳定，但接受医疗补助的成人的艾德就诊率从1999年的66.4增加到2007年的83.9（率差，17.5; 95% CI，-5.8至40.8;趋势P= 0.007）。符合安全网ED条件的机构数量从2000年的1770家增加到2007年的2489家。结论这些研究结果表明，艾德就诊率从1997年到2007年有所增加，ED越来越多地成为医疗服务不足患者，特别是医疗补助成年人的安全网。美国医学会杂志2010;304（6）：664-670
Context The potential effects of increasing numbers of uninsured and underinsured persons on US emergency departments (EDs) is a concern for the health care safety net.Objective To describe the changes in ED visits that occurred from 1997 through 2007 in the adult and pediatric US populations by sociodemographic group, designation of safety-net ED, and trends in ambulatory care sensitive conditions.Design, Setting, and Participants Publicly available ED visit data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1997 through 2007 were stratified by age, sex, race, ethnicity, insurance status, safety-net hospital classification, triage category, and disposition. Codes from the International Classification of Diseases, Ninth Revision (ICD-9), were used to extract visits related to ambulatory care sensitive conditions. Visit rates were calculated using annual US Census estimates.Main Outcome Measures Total annual visits to US EDs and ED visit rates for population subgroups.Results Between 1997 and 2007, ED visit rates increased from 35.8 to 390.5 per 1000 persons (rate difference, 37.7; 95% confidence interval [Cl], -51.1 to 126.5; P=.001 for trend); the increase in total annual ED visits was almost double of what would be expected from population growth. Adults with Medicaid accounted for most of the increase in ED visits; the visit rate increased from 693.9 to 947.2 visits per 1000 enrollees between 1999 and 2007 (rate difference, 253.3; 95% Cl, 41.1 to 465.5; P=.001 for trend). Although ED visit rates for adults with ambulatory care sensitive conditions remained stable, ED visit rates among adults with Medicaid increased from 66.4 in 1999 to 83.9 in 2007 (rate difference, 17.5; 95% Cl, -5.8 to 40.8; P=.007 for trend). The number of facilities qualifying as safety-net EDs increased from 1770 in 2000 to 2489 in 2007.Conclusion These findings indicate that ED visit rates have increased from 1997 to 2007 and that EDs are increasingly serving as the safety net for medically underserved patients, particularly adults with Medicaid. JAMA. 2010;304(6):664-670