Social determinants and emergency department utilization: Findings from the Veterans Health Administration
Social determinants and emergency department utilization: Findings from the Veterans Health Administration
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DOI：
10.1016/j.ajem.2020.05.078
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发表时间：
2020-09-01
影响因子：
3.6
通讯作者：
Blosnich, John R.
中科院分区：
文献类型：
--
作者：
Davis, Camille, I;Montgomery, Ann Elizabeth;Blosnich, John R.
背景资料：健康的社会决定因素（SDH）是发病率和死亡率的强有力的预测因素，但卫生保健系统的努力，以整合的方式，可用于卫生服务研究的SDH文件到健康记录。鉴于社会因素对健康的影响，检查与急诊科（艾德）利用的关系非常重要。目的：使用退伍军人健康管理局（VHA）的电子健康记录（EHR）数据检查SDH的七项指标与艾德利用之间的关联。方法：这项横断面分析包括所有患者的数据，这些患者从10月1日起在退伍军人综合服务网络4区至少有一次医疗保健访问，2015年至2016年9月30日（n= 293，872）。七类不良社会发展需求包括暴力、住房不稳定、就业或财务问题、法律的问题、社会或家庭问题、缺乏获得护理或交通的机会，以及通过电子健康记录中的结构化编码确定的非特定心理社会需求。负二项回归被用来检查的计数不良SDH（0-7）与计数的艾德visits，调整社会人口和健康相关factors.Results的关联：大约18%的患者访问的艾德在观察期间。校正协变量后，SDH不良反应与VHA艾德使用呈正相关。每一个SDH指标，比法律的问题，是正相关的增加艾德utilization.Conclusion：即使在占几个人口和健康相关因素，不利的SDH表现出强烈的正相关与VHA艾德利用。爱思唯尔公司出版
Background: Social determinants of health (SDH) are strong predictors of morbidity and mortality but health care systems struggle to integrate documentation of SDH into health records in ways that can be used for health services research. Given the impact of social factors on health, it is important to examine the relationship with emergency department (ED) utilization.Objective: To examine the association between seven indicators of SDH and ED utilization using electronic health record (EHR) data from the Veterans Health Administration (VHA).Methods: This cross-sectional analysis included data from all patients who had at least one health care visit in the Veterans Integrated Service Network region 4 from October 1, 2015 through September 30, 2016 (n=293,872). Seven categories of adverse SDH included violence, housing instability, employment or financial problems, legal problems, social or family problems, lack of access to care or transportation, and non-specific psychosocial needs identified through structured coding in EHR. Negative binomial regression was used to examine the association of the count of adverse SDH (0-7) with the count of ED visits, adjusting for socio-demographic and health-related factors.Results: Approximately 18% of patients visited the ED during the observation period. After adjusting for covariates, adverse SDH were positively associated with VHA ED utilization. Each of the SDH indicators, other than legal issues, was positively associated with increased ED utilization.Conclusion: Even after accounting for several demographic and health-related factors, adverse SDH demonstrated strong positive associations with VHA ED utilization. Published by Elsevier Inc.