Geographic variation in the demand for emergency care: A local population-level analysis
Geographic variation in the demand for emergency care: A local population-level analysis
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DOI：
10.1016/j.hjdsi.2015.05.003
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发表时间：
2016-06-01
影响因子：
2.5
通讯作者：
Carr, Brendan G.
中科院分区：
文献类型：
--
作者：
Lee, David C.;Doran, Kelly M.;Carr, Brendan G.
背景：医疗保健的地理差异传统上是在医院转诊区或服务区等大区域进行研究的。这些分析受到当地社区存在的差异的限制。材料和方法：使用纽约索赔数据库，我们分析了2008年至2012年4797个人口普查区（比通常研究的单位小）中3500万次就诊的急诊科使用情况的变化。使用多变量分析，我们研究了人群特征和接近医疗保健与急诊科使用率之间的关系。我们分析了与急诊科使用率相关的因素在城市、郊区和农村地区的差异。结果：我们发现在人口普查区急诊科的使用存在显著的地理差异。在所有类型的地区，公共保险和无保险与急诊科的高使用率相关。我们发现，种族、民族和贫困仅与城市地区急诊科的高使用率有关。在郊区和农村地区，老年居民比例较低、到最近的急诊室距离较短与急诊使用率高相关。结论：在小的地理区域内，急诊科的使用存在显著差异。保险类型与城市、郊区和农村地区急诊科使用的差异显著相关，而其他因素的重要性取决于城市化程度。意义：在更细粒度的水平上研究地理差异可以更好地了解当地人口健康、医疗保健利用的驱动因素，并为有针对性的干预提供信息。鉴于人口普查区急诊科使用的异质性，制定急症护理利用的政策必须考虑这些地方地理差异。(C) 2015爱思唯尔公司版权所有。
Background: Geographic variation in healthcare has been traditionally studied in large areas such as hospital referral regions or service areas. These analyses are limited by variation that exists within local communities.Materials and methods: Using a New York claims database, we analyzed variation in emergency department use using 35 million visits from 2008 to 2012 among 4797 Census tracts, a smaller unit than usually studied. Using multivariate analysis, we studied associations between population characteristics and proximity to healthcare with rates of emergency department use. We analyzed how factors associated with emergency department utilization differed among urban, suburban, and rural regions.Results: We found significant geographic variation in emergency department use among Census tracts. Public insurance and uninsurance were correlated with high emergency department utilization across all types of regions. We found that race, ethnicity, and poverty were only associated with high emergency department use in urban regions. In suburban and rural regions, a lower proportion of elderly residents and shorter distances to the nearest ED were correlated with high emergency department use.Conclusions: Significant variation in emergency department use exists locally when studied within small geographic areas. Insurance type is significantly associated with variation in emergency department use across urban, suburban, and rural regions, whereas the significance of other factors depended on urbanicity.Implications: Studying geographic variation at a more granular level can lead to better understanding of local population health, drivers of healthcare utilization, and inform targeted interventions. Given heterogeneity in emergency department use by Census tract, policies directed at shaping acute care utilization must consider these local geographic differences. (C) 2015 Elsevier Inc. All rights reserved.