FACTORS ASSOCIATED WITH AMBULANCE USE AMONG PATIENTS WITH LOW-ACUITY CONDITIONS
FACTORS ASSOCIATED WITH AMBULANCE USE AMONG PATIENTS WITH LOW-ACUITY CONDITIONS
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DOI：
10.3109/10903127.2012.670688
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发表时间：
2012-07-01
影响因子：
2.4
通讯作者：
Fahimi, Jahan
中科院分区：
文献类型：
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作者：
Durant, Edward;Fahimi, Jahan
背景使用救护车处理低急性医疗投诉耗尽了可用于高急性状况的紧急医疗服务（EMS）资源，并导致急诊室（艾德）过度拥挤和救护车分流。Objective.我们试图了解使用救护车治疗低敏度疾病的患者的特征。我们假设，因低敏度状况而乘坐救护车到达艾德的患者更有可能是弱势群体的成员。方法.对全国医院门诊医疗调查（NHAMCS）进行了次要分析。我们只纳入了年龄在18岁或以上的患者，他们在急诊室就诊时被分类为“非紧急”类别。为了比较救护车到达的患者与所有其他模式到达的患者，使用广义线性模型进行多变量logistic回归，并计算校正的相对风险（ARR）。结果1997年至2008年（不包括2001-2002年）共有16 109份记录被纳入分析。低敏度条件下使用救护车的比率显著较高与：1）年龄较大（ARR 1.30，95%置信区间[CI]：1.18-1.43;每10年）; 2）Medicare或Medicaid保险（ARR 1.81，95% CI：1.36-2.41和ARR 1.46，95% CI：1.12-1.91）; 3）无家可归（ARR 3.30，95% CI：1.61-6.78）; 4）在11 PM至6：59 AM之间到达（ARR 1.80，95% CI：1.43-2.27）;和5）某些主诉类别：精神病（ARR 1.78，95% CI：1.03-3.07）、毒理学/中毒（ARR 3.26，95% CI：1.85-5.76）和神经学/心理学（ARR 1.71，95% CI：1.34-2.18）。救护车到达的患者比非救护车患者更有可能接受实验室诊断检查（ARR 3.50，95% CI：2.80-4.39），放射学成像（ARR 2.26，95% CI：1.91-2.68）和住院（ARR 3.99，95% CI：3.03-5.27）。结论我们的研究建立在一系列工作的基础上，这些工作强调了与救护车运输到急诊室相关的因素，证实了某些弱势群体不成比例地使用救护车，并可能为旨在增加这些患者获得非救护车运输和紧急护理的干预措施提供信息。
Background. The use of ambulances for low-acuity medical complaints depletes emergency medical services (EMS) resources that could be used for higher-acuity conditions and contributes to emergency department (ED) overcrowding and ambulance diversion. Objective. We sought to understand the characteristics of patients who use ambulances for low-acuity conditions. We hypothesized that patients who arrive to the ED by ambulance for low-acuity conditions are more likely to be members of vulnerable populations. Methods. A secondary analysis was performed on the National Hospital Ambulatory Medical Care Survey (NHAMCS). We included only patients aged 18 years or older who were triaged to the "nonurgent" category upon presentation to the ED. To compare patients who arrived by ambulance with those who arrived by all other modes, multivariate logistic regression was performed using a generalized linear model, and adjusted relative risks (ARRs) were calculated. Results. A total of 16,109 records from 1997 to 2008 (excluding 2001-2002) were included in the analysis. Significantly higher rates of ambulance use for low-acuity conditions were associated with: 1) older age (ARR 1.30, 95% confidence interval [CI]: 1.18-1.43; per 10 years); 2) Medicare or Medicaid insurance (ARR 1.81, 95% CI: 1.36-2.41, and ARR 1.46, 95% CI: 1.12-1.91, respectively); 3) homelessness (ARR 3.30, 95% CI: 1.61-6.78); 4) arrival between 11 PM and 6: 59 AM (ARR 1.80, 95% CI: 1.43-2.27); and 5) certain chief complaint categories: psychiatric (ARR 1.78, 95% CI: 1.03-3.07), toxicologic/poisoning (ARR 3.26, 95% CI: 1.85-5.76), and neurologic/psychological (ARR 1.71, 95% CI: 1.34-2.18). Patients who arrived by ambulance were more likely than nonambulance patients to receive laboratory diagnostic tests (ARR 3.50, 95% CI: 2.80-4.39), radiographic imaging (ARR 2.26, 95% CI: 1.91-2.68), and admission to the hospital (ARR 3.99, 95% CI: 3.03-5.27). Conclusion. Our study builds on a body of work highlighting the factors associated with ambulance transport to EDs, confirms that certain vulnerable populations disproportionately use ambulances, and may inform interventions aimed at increasing access to nonambulance transportation and urgent care for these patients.