Factors Associated With Emergency Department Use Among the Rural Elderly
Factors Associated With Emergency Department Use Among the Rural Elderly
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DOI：
10.1111/j.1748-0361.2010.00313.x
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发表时间：
2011-12-01
影响因子：
4.9
通讯作者：
Friedman, Bruce
中科院分区：
文献类型：
--
作者：
Fan, Lin;Shah, Manish N.;Friedman, Bruce
背景：农村老年人使用急诊科（ED）的模式可能与城市老年人不同，因此需要不同的政策举措。然而，农村老年人的ED使用很少被研究，也很少被理解。目的：探讨农村老年人使用ED与不使用ED的相关因素。方法：对居住在非大都市地区的1736名65岁及以上的医疗保险受益人进行横断面和观察性研究。数据来自2002年至2005年医疗支出小组调查。根据Anderson的卫生服务利用行为模型，估计了一个包括易感特征、使能因素、需求变量和健康行为的logistic回归模型。结果：在1年期间，20.8%的样本至少有1次ED就诊。丧偶、受教育程度较高、参加医疗补助计划、自我感觉身体健康状况一般/较差、患有呼吸系统疾病和心脏病的人更有可能去急诊室就诊。然而，居住在美国西部和南部，并参加了医疗补助管理的医疗服务的人，去急诊室就诊的可能性较低。报告身体健康状况优秀、非常好、良好或一般的医疗补助参保者比没有接受医疗补助的参保者至少有1次急诊就诊的可能性更大，报告身体健康状况不佳的医疗补助参保者可能很少有急诊就诊的可能性。结论：政策制定者和医院管理者在管理急诊需求时应考虑这些因素，包括制定干预措施，通过替代手段提供所需的护理。
Context: Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood.Purpose: To characterize factors associated with having any versus no ED use among the rural elderly.Methods: A cross-sectional and observational study of 1,736 Medicare beneficiaries age 65 and older who live in nonmetropolitan areas. The data are from the 2002 to 2005 Medical Expenditure Panel Survey (MEPS). A logistic regression model was estimated that included measures of predisposing characteristics, enabling factors, need variables, and health behavior as suggested by Anderson's behavioral model of health service utilization.Findings: During a 1-year period, 20.8% of the sample had at least 1 ED visit. Being widowed, more educated, enrolled in Medicaid, with fair/poor self-perceived physical health, respiratory diseases, and heart disease were associated with a higher likelihood of having any ED visits. However, residing in the western and southern United States and being enrolled in Medicaid managed care were associated with lower probability of having any ED visits. While Medicaid enrollees who reported excellent, very good, good, or fair physical health were more likely to have at least 1 ED visit than those not on Medicaid, Medicaid enrollees reporting poor physical health may be less likely to have any ED visits.Conclusion: Policy makers and hospital administrators should consider these factors when managing the need for emergency care, including developing interventions to provide needed care through alternate means.