Accountable Care Hospitals and Preventable Emergency Department Visits for Rural Dementia Patients.
Accountable Care Hospitals and Preventable Emergency Department Visits for Rural Dementia Patients.
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DOI：
10.1111/jgs.16858
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发表时间：
2021-01
影响因子：
6.3
通讯作者：
Chen J
中科院分区：
文献类型：
--
作者：
Wang N;Amaize A;Chen J
本研究探讨了阿尔茨海默病和相关痴呆症（ADRD）患者可预防急诊（艾德）就诊频率的城乡差异，重点是城市和农村地区医院的责任护理组织（ACO）参与状况的变化。我们使用2015年国家急诊部门数据库，美国医院协会年度医院调查和地区卫生资源文件进行了一项横断面研究。个体、县和医院水平的特征和州固定效应用于模型规范。来自七个州的ADRD患者，他们访问了艾德并进行了常规出院。我们的样本包括117，196例ADRD患者。结果是可预防的艾德就诊，使用纽约大学（NYU）急诊科就诊算法进行分类。我们进行了多变量逻辑回归，以估计城市和农村地区可预防的艾德就诊的变化。与城市患者相比，农村ADRD患者去艾德进行可预防性就诊的调整后比值高1.13（P = 0.007）。此外，与不隶属于ACO的医院相比，ACO附属医院ADRD患者可预防艾德就诊的调整比值低0.91（P = 0.005）。全县精神卫生保健卫生专业人员短缺地区（HPSA）（OR = 1.14，P = 0.002）的指定也是一个较高的可预防艾德率的指标。ACO输送系统有可能减少农村ADRD患者中可预防的艾德就诊。
This study examined urban/rural differences in the frequency of preventable Emergency Department (ED) visits among patients with Alzheimer’s Disease and Related Dementias (ADRD), with a focus on the variation of Accountable Care Organization (ACO) participation status for hospitals in urban and rural areas. We performed a cross-sectional study using the 2015 State Emergency Department Databases, the American Hospital Association Annual Survey of Hospitals, and the Area Health Resource File. Individual-, county-, and hospital-level characteristics and state fixed effects were used for model specification. Patients with ADRD from seven states who visited the ED and had routine discharges. Our sample consists of 117,196 patients with ADRD. The outcome was preventable ED visits which was classified using the New York University (NYU) Emergency Department visit algorithm. We performed a multivariable logistic regression to estimate the variation of preventable ED visits by urban and rural areas. Rural patients with ADRD had 1.13 higher adjusted odds (P = 0.007) of going to the ED for a preventable visit compared to their urban counterparts. In addition, ACO-affiliated hospitals had 0.91 lower adjusted odds (P = 0.005) of preventable ED visits for ADRD patients compared to hospitals not affiliated with an ACO. Whole County Mental Health Care Health Professional Shortage Area (HPSA) (OR = 1.14, P = 0.002) designation was also an indicator of higher preventable ED rates. ACO delivery systems have the potential to decrease rural preventable ED visits among ADRD patients.
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影响因子：
14
作者：
通讯作者：
--
影响因子：
9.7
作者：
Lewis, Valerie A.;Fraze, Taressa;Colla, Carrie H.
通讯作者：
Colla, Carrie H.
影响因子：
6.3
作者：
Carpenter, Christopher R.;McFarland, Frances;Verghese, Joe
通讯作者：
Verghese, Joe
影响因子：
39
作者：
Nyweide, David J.;Anthony, Denise L.;Fisher, Elliott S.
通讯作者：
Fisher, Elliott S.
DOI：
10.1111/jrh.12465
发表时间：
2021-06
期刊：
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
影响因子：
--
作者：
Wang N;Albaroudi A;Chen J
通讯作者：
Chen J