Decomposing Urban and Rural Disparities of Preventable ED Visits Among Patients With Alzheimer's Disease and Related Dementias: Evidence of the Availability of Health Care Resources.
Decomposing Urban and Rural Disparities of Preventable ED Visits Among Patients With Alzheimer's Disease and Related Dementias: Evidence of the Availability of Health Care Resources.
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阿尔茨海默病和相关痴呆患者中可接受的艾德就诊的城乡差异：卫生保健资源可用性的证据。
DOI：
10.1111/jrh.12465
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Chen J
中科院分区：
文献类型：
--
作者：
Wang N;Albaroudi A;Chen J
本研究的目的是检查阿尔茨海默病和相关痴呆（ADRD）患者可预防的急诊（艾德）就诊频率的城乡差异，重点是城乡地区的医疗保健资源的可用性。使用了来自医疗保健成本和利用项目和地区卫生资源文件的2015年国家紧急部门数据库的链接数据集。我们的分析包括7个州的艾德放电。我们进行了状态固定效应多变量逻辑回归，以估计城市和农村地区可预防ED的变化。个人特征和县级卫生保健资源被纳入估计。瓦哈卡分解被用来量化县级卫生保健资源和城市/农村差距的关联。与城市患者相比，农村ADRD患者去艾德进行可预防性就诊的校正比值高1.23（P <0.001）。分解结果显示，模型说明解释了49.2%的城乡患者差异。居住在精神卫生专业人员短缺地区的患者是造成城乡差异的驱动因素之一（占27%-48%）。我们的研究表明，改善农村地区的卫生保健资源，以提高卫生保健质量和ADRD患者谁居住在农村地区的结果的重要性。未来的研究和未观察到的因素，如医疗保健质量的数据收集，将有助于解释的地理差异。
The purpose of this study was to examine the urban and rural differences in the frequency of preventable Emergency Department (ED) visits among Alzheimer’s Disease and Related Dementias (ADRD) patients, with a focus on the availability of health care resources in urban and rural areas. Linked datasets of 2015 State Emergency Department Databases from the Healthcare Cost and Utilization Project and the Area Health Resource File were used. ED discharges of 7 states were included in our analysis. We performed a state fixed-effect multivariable logistic regression to estimate the variation of preventable EDs by urban and rural areas. Individual characteristics and county-level health care resources were included in the estimation. The Oaxaca decomposition was used to quantify the association of county-level health care resources and urban/rural disparities. Rural patients with ADRD had 1.23 higher adjusted odds (P < .001) of going to the ED for a preventable visit compared to urban counterparts. The decomposition results showed that the model specification explained 49.2% of the differences between urban and rural patients. Patient residence in a mental health professional shortage area is one of the driving factors (contributing to 27%−48%) that explained the urban and rural disparities. Our study demonstrates the importance of improving health care resources in rural areas to improve health care quality and outcomes among ADRD patients who reside in rural areas. Future research and data collection on unobserved factors, such as health care quality, will be helpful in explaining the geographic differences.
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DOI：
10.1093/geronb/gbx135
发表时间：
2018-05-01
影响因子：
6.2
作者：
Crimmins, Eileen M.;Saito, Yasuhiko;Hayward, Mark D.
通讯作者：
Hayward, Mark D.
影响因子：
14
作者：
通讯作者：
--
影响因子：
3.9
作者：
Delavar, Arash;Al Jammal, Omar M.;Pham, Martin H.
通讯作者：
Pham, Martin H.
影响因子：
1.4
作者：
Conway P;Favet H;Hall L;Uhrich J;Palche J;Olimb S;Tesch N;York-Jesme M;Bianco J
通讯作者：
Bianco J
影响因子：
6.3
作者：
Flaherty, Ellen;Bartels, Stephen J.
通讯作者：
Bartels, Stephen J.