The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured
The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured
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DOI：
10.1093/pubmed/fds027
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发表时间：
2012-12-01
影响因子：
4.4
通讯作者：
Walton, J.
中科院分区：
文献类型：
--
作者：
DeHaven, M.;Kitzman-Ulrich, H.;Walton, J.
背景大约有19%的非老年成年人没有医疗保险。没有保险的人往往缺乏初级保健来源，更有可能使用急诊科(ED)进行常规护理。改善未参保者获得初级保健的机会是减少ED过度使用和相关费用的策略之一。方法采用对照组准实验设计，评估为未参保者提供初级保健服务的广泛社区伙伴关系对ED利用率和相关费用的影响。在急诊室看到的符合条件的未参保患者被登记在PAD(N 265)，类似的未在PAD登记的患者(N 309)作为对照。研究患者的年龄为1865岁，是联邦贫困水平的200岁，没有保险。结果参加PAD计划的患者急诊次数(0.93vs.1.44；P0.01)和住院天数(0.37vs.1.07；P0.05)显著低于对照组。直接住院费用减少约60美元(1188美元比446美元；P0.01)，间接费用减少50美元(313美元比692美元；P0.01)。结论广泛的社区合作计划可以显著降低未参保人群的ED使用率和相关成本。
Background Approximately 19 of non-elderly adults are without health insurance. The uninsured frequently lack a source of primary care and are more likely to use the emergency department (ED) for routine care. Improving access to primary care for the uninsured is one strategy to reduce ED overutilization and related costs.Methods A comparison group quasi-experimental design was used to evaluate a broad-based community partnership that provided access to care for the uninsuredProject Access Dallas (PAD)on ED utilization and related costs. Eligible uninsured patients seen in the ED were enrolled in PAD (n 265) with similar patients not enrolled in PAD (n 309) serving as controls. Study patients were aged 1865 years, 200 of the federal poverty level and uninsured. Outcome measures include the number of ED visits, hospital days and direct and indirect costs.Results PAD program enrollees had significantly fewer ED visits (0.93 vs. 1.44; P 0.01) and fewer inpatient hospital days (0.37 vs. 1.07; P 0.05) than controls. Direct hospital costs were approximate to 60 less ($1188 vs. $446; P 0.01) and indirect costs were 50 less ($313 vs. $692; P 0.01).Conclusions A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.