Possible geographical barriers to trauma center access for vulnerable patients in the United States: an analysis of urban and rural communities.
Possible geographical barriers to trauma center access for vulnerable patients in the United States: an analysis of urban and rural communities.
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DOI：
10.1001/archsurg.2010.299
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发表时间：
2011-01
影响因子：
--
通讯作者：
Shen, Yu-Chu
中科院分区：
文献类型：
--
作者：
Hsia, Renee;Shen, Yu-Chu
研究传统弱势群体前往创伤中心的地理条件是否较差。使用美国医院协会 2005 年年度调查的数据与美国人口普查的邮政编码级数据进行横断面分析。我们使用多项 Logit 模型来检查特定弱势群体亚群难以进入创伤中心与容易进入创伤中心的可能性。美国邮政编码定义的农村和城市社区的人口。每个社区到最近的创伤中心的距离（I-III 级）。在城市地区，67% 的人口可以轻松前往创伤中心，12% 的人口难以前往，而农村地区这一比例分别为 24% 和 31%。 2005 年，下列弱势人口群体比例较高的地区面临获得创伤中心服务困难的风险（比值比）较高： 出生在城市地区的外国人（中等比例为 1.65，高比例为 2.18 [均 P < .01]）；城市和农村地区的非裔美国人（中等比例分别为 1.25，高比例分别为 1.35 [均 P < .05]）；城市和农村地区的贫困人口和准贫困人口（高比例分别为 1.52 [P < .05] 和 1.69 [P < .01]）。很大一部分美国人口（即 3840 万人）无法在开车 1 小时内获得创伤护理。此外，某些弱势群体比其他群体面临更高的风险，因为他们更难进入创伤中心。利益相关者和卫生保健规划者应在开发创伤系统时考虑这些因素，因为潜在需求和获取机会的不匹配可能表明护理提供效率低下。
To study whether traditionally vulnerable populations have worse geographic access to trauma centers. A cross-sectional analysis using data from the American Hospital Association Annual Survey from 2005 linked with zip code–level data from the US Census. We used a multinomial logit model to examine the odds of having difficult as opposed to easy access to trauma centers for a given subgroup of vulnerable populations. Population in rural and urban communities as defined by zip codes in the United States. Each community’s distance to the nearest trauma center (levels I–III). In urban areas, 67% of the population had easy access to trauma centers and 12% had difficult access compared with 24% and 31% in rural areas, respectively. Areas with higher shares of the following vulnerable population groups had higher risks (odds ratios) of facing difficult access to trauma center services in 2005: foreign born in urban areas (1.65 for a medium share and 2.18 for a high share [both P < .01]); African American in urban and rural areas (1.25 for a medium share and 1.35 for a high share, respectively [both P < .05]); and near-poor in urban and rural areas (1.52 [P < .05] and 1.69 [P < .01] for a high share, respectively). A significant segment of the US population (representing 38.4 million people) does not have access to trauma care within 1 hour of driving time. Moreover, certain vulnerable groups are at higher risk than others for worse access to trauma centers. Stakeholders and health care planners should consider these factors in the development of trauma systems because a mismatch of potential need and access could signal inefficiencies in the delivery of care.
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DOI：
10.1097/00005373-199611000-00021
发表时间：
1996-11-01
影响因子：
--
作者：
Bazzoli, GJ;Meersman, PJ;Chan, C
通讯作者：
Chan, C
影响因子：
5.4
作者：
LOVE, RF;MORRIS, JG
通讯作者：
MORRIS, JG
影响因子：
120.7
作者：
MacKenzie, EJ;Hoyt, DB;Teter, H
通讯作者：
Teter, H
影响因子：
--
作者：
Haider, Adil H.;Chang, David C.;Cornwell, Edward E., III
通讯作者：
Cornwell, Edward E., III
影响因子：
4.4
作者：
Lerner, EB;Moscati, RM
通讯作者：
Moscati, RM