Health care utilization of chronic inebriates.
Health care utilization of chronic inebriates.
复制标题
慢性醉酒者的保健利用。
DOI：
10.1197/aemj.9.4.300
复制
发表时间：
2002
期刊：
影响因子：
--
通讯作者：
S. Sterner
中科院分区：
文献类型：
--
作者：
L. Thornquist;M. Biros;RobertT. Olander;S. Sterner
未标记
慢性醉酒者经常使用紧急服务，包括急诊科（艾德），因为他们缺乏其他资源或获得初级保健。由于他们复杂的医疗需求，这往往是加剧了急性中毒和相关的疾病或伤害，相对少数的急性中毒慢性醉酒可以伸展艾德资源，并有助于艾德过度拥挤。
目的
为了解决这一问题以及其他县服务的过度使用问题，制定了三个县方案（针对种族和性别的支助性住房;强化街头案件管理），以减少紧急资源的使用，同时仍然提供安全的环境。这项研究确定了这些方案的有效性。作者假设，该计划的招募将减少该患者人群的医疗和解毒（排毒）支出。
方法
在戒毒和医疗访问，保险天数和费用的数量进行了前和后计划的比较。从医院和健康计划账单和县数据库中检索数据（有患者的书面知情同意）。描述性统计比较了入组前和入组后的组。最小二乘回归预测总的和非住院医疗费用。
结果
122名患者中有92名获得了完整数据（平均年龄= 47岁; 60%是美洲原住民; 93%是男性）; 7名患者患有严重疾病或受伤，偏离了平均值。然而，年度排毒访视（10比1）和医疗访视（11比8）的中位数以及医疗费用中位数（5，436美元至2，770美元）和总医疗费用（9，297美元至5，218美元）的整体显着下降。投保天数中位数增加（284天至353天）。通过回归分析，受伤是最重要的预程序预测的医疗费用，疾病驱动器后进入收费。酒精相关的访问增加到模型之前进入，但消失后进入。
结论
这些计划减少了大多数患者的医疗保健使用。然而，少数病人的严重医疗疾病或伤害严重影响了资源的利用。
UNLABELLED
Chronic inebriates often use emergency services, including the emergency department (ED), because they lack other resources or access to primary care. Because of their complicated medical needs, which are often exacerbated by acute intoxication and related illness or injury, a relatively small number of acutely intoxicated chronic inebriates can stretch ED resources and contribute to ED over-crowding.
OBJECTIVE
In order to address this, as well as overutilization of other county services, three county programs were developed (ethnic- and gender-specific supportive housing; intensive street case management) to reduce emergency resource utilization while still providing a safe environment. This study determined the effectiveness of these programs. The authors hypothesized that program enrollment would reduce medical and detoxification (detox) expenditures for this patient population.
METHODS
Pre- and postprogram comparisons were made on the number of detox and medical visits, insured days, and charges. Data were retrieved (with patients' written informed consent) from hospital and health plan billings and county databases. Descriptive statistics compared groups pre and post enrollment. Least-squares regression predicted total and non-inpatient medical charges.
RESULTS
Complete data were available for 92 of 122 patients (mean age = 47 years; 60% Native American; 93% male); seven had severe illnesses or injuries, skewing the mean. However, there were significant overall reductions in the median numbers of yearly detox visits (10 to 1) and medical visits (11 to 8), and in median medical charges ($5,436 to $2,770) and total health care charges ($9,297 to $5,218). The median number of days insured increased (284 to 353). By regression analysis, injury was the most important preprogram predictor of medical charges; illness drives charges post-entry. Alcohol-related visits added to the model before entry but disappeared post-entry.
CONCLUSIONS
These programs reduced health care use for most patients. However, serious medical illness or injury in a small number of patients contributed heavily to resource utilization.