Trends and predictors of hospitalization after emergency department asthma visits among U.S. Adults, 2006-2014.
Trends and predictors of hospitalization after emergency department asthma visits among U.S. Adults, 2006-2014.
复制标题
DOI：
10.1080/02770903.2019.1621889
复制
发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Richardson LD
中科院分区：
文献类型：
--
作者：
Lin MP;Vargas-Torres C;Schuur JD;Shi D;Wisnivesky J;Richardson LD
哮喘住院治疗是一种对门诊护理敏感的疾病；大多数患者来自急诊科。描述源于急诊室的成人哮喘住院的趋势和预测因素。使用具有全国代表性的样本对急诊科就诊导致住院的观察性研究。我们使用Logistic回归检验2006-2014年间住院率的趋势，然后使用考虑医院级聚类的分层多变量回归来评估住院率与患者和医院特征之间的关联。从2006年到2014年，ED哮喘的总就诊次数增加了15%，从106万增加到122万，而住院的可能性下降了(20.9%到18.2%，p<；0.01)。经哮喘患病率上升调整后，急诊就诊率和住院率分别下降了10%和21%。住院时间与年龄、女性(OR=1.23，95%CI 1.20~1.26)、较高的Charlson评分(OR=1.99，95%CI 1.97~2.01)、医疗补助(OR=1.05，95%CI 1.01~1.08)、医疗保险(OR=1.26，95%CI 1.22~1.31)、创伤中心(OR=1.34，95%CI 1.12~1.60)独立相关。无保险就诊(OR=0.7，95%CI 0.67~0.73)、低收入地区(OR=0.89，95%CI 0.85~0.93)、非大中城市教学医院(OR=0.83，95%CI 0.71~0.96)、中西部地区(OR=0.84，95%CI 0.69~1.01)、西部地区(OR 0.69，95%CI 0.56~0.83)住院的可能性较小。在对患者和医院因素进行调整后，未测量的特定于医院的影响占住院率变异性的15.8%。哮喘急诊总人次增加，但经患病率调整的急诊人次和急诊住院率下降。没有保险的患者去急诊室就诊的比例不成比例，但住院几率低30%。显著的差异意味着不可测量的临床、社会和环境因素，这是医院特定住院差异的原因。成人ED哮喘就诊总数增加，但经患病率调整的ED就诊次数和ED住院人数下降。低收入和未参保的患者住院的可能性较小，这表明健康差距持续存在。哮喘住院治疗可以通过高质量的初级保健来预防。我们证明，经患病率调整后的美国成人ED哮喘就诊率和来自ED的住院率正在下降，但仍受到几个非临床患者和医院因素的影响。
Asthma hospitalizations are an ambulatory care-sensitive condition; a majority originate in emergency departments (EDs). Describe trends and predictors of adult asthma hospitalizations originating in EDs. Observational study of ED visits resulting in hospitalization using a nationally representative sample. We tested trend in hospitalization rates from 2006–2014 using logistic regression, then assessed the association between hospitalization rates and patient and hospital characteristics using hierarchical multivariable regression accounting for hospital-level clustering. Total ED asthma visits increased 15% from 2006-2014, from 1.06 to 1.22 million, while the likelihood of hospitalization decreased (20.9% to 18.2%, p<0.01). Adjusting for increased asthma prevalence, ED visit rates and hospitalization rates decreased by 10% and 21%, respectively. Hospitalization was independently associated with older age, female gender (OR=1.23, 95%CI 1.20-1.26), higher Charlson score (OR=1.99, 95%CI 1.97-2.01), Medicaid (OR=1.05, 95%CI 1.01-1.08) and Medicare (OR=1.26, 95%CI 1.22-1.31) insurance, and trauma centers (OR=1.34, 95%CI 1.12-1.60). Hospitalization was less likely for uninsured visits (OR=0.7, 95%CI 0.67-0.73), lower income areas (OR=0.89, 95%CI 0.85-0.93), non-metropolitan teaching hospitals (OR=0.83, 95%CI 0.71-0.96), Midwestern (OR=0.84, 95%CI 0.69-1.01) or Western regions (OR 0.69, 95%CI 0.56-0.83). Unmeasured hospital-specific effects account for 15.8% of variability in hospital admission rates after adjusting for patient and hospital factors. Total asthma ED visits increased, but prevalence-adjusted ED visits, and ED hospitalization rates have declined. Uninsured patients have disproportionately more ED visits but 30% lower odds of hospitalization. Substantial variation implies unmeasured clinical, social and environmental factors accounting for hospital-specific differences in hospitalization. Total adult ED asthma visits increased, but prevalence-adjusted ED visits, and hospitalizations from the ED have declined. Low-income and uninsured patients are less likely to be hospitalized, suggesting persistent health disparities. Asthma hospitalizations may be preventable through high quality primary care. We demonstrate prevalence-adjusted U.S. adult ED asthma visits and hospitalization rates from the ED are decreasing, but still affected by several non-clinical patient and hospital factors.
登录
查看更多内容
影响因子：
4.4
作者：
Trachtenberg, Aaron J.;Dik, Natalia;Katz, Alan
通讯作者：
Katz, Alan
影响因子：
2.8
作者：
Li B;Evans D;Faris P;Dean S;Quan H
通讯作者：
Quan H
影响因子：
5.9
作者：
Lang, David M.;Polansky, Marcia;Sherman, Michael S.
通讯作者：
Sherman, Michael S.
影响因子：
14.2
作者：
Sullivan, Patrick W.;Ghushchyan, Vahram H.;Lin, Shao-Lee
通讯作者：
Lin, Shao-Lee
影响因子：
5.9
作者：
Fleetcroft, Robert;Noble, Michael;Steel, Nicholas
通讯作者：
Steel, Nicholas