Does Spatial Access to Primary Care Affect Emergency Department Utilization for Nonemergent Conditions?
Does Spatial Access to Primary Care Affect Emergency Department Utilization for Nonemergent Conditions?
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DOI：
10.1111/1475-6773.12617
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发表时间：
2018-02-01
影响因子：
3.4
通讯作者：
Galanter, William
中科院分区：
文献类型：
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作者：
Fishman, Jamie;McLafferty, Sara;Galanter, William
目的探讨个人和社区一级的空间访问的贡献，以照顾利用急诊科（ED）的可预防的条件，通过实施新的本地空间访问measurements.Data Sources/Study SettingEmergency department admissions data are from four HealthLNK member hospitals in芝加哥从2007年至2011年。初级保健医生的办公室和诊所的位置，从美国医学会和芝加哥市获得。研究设计Multilevel logit regression被用来模拟个人和邻里水平的属性和可预防的艾德use.Data Collection/Extraction MethodsEmergency department admissions data进行了分类的基础上，每个遭遇的主要诊断。在ArcGIS中生成护理指数的空间访问，并在每个邮政编码质心提取值以匹配患者的邮政编码。主要发现除了性别和种族等社会人口因素外，生活在医疗服务不足地区（MUA）和初级保健诊所空间访问较少的地区的患者使用可预防艾德的几率较高。结论可预防艾德的使用与社会人口特征相关，以及获得初级保健服务的空间。这项研究揭示了潜在的可预防的艾德分析使用当地的空间可达性措施。
ObjectiveTo examine the contributions of individual- and neighborhood-level spatial access to care to the utilization of emergency departments (EDs) for preventable conditions through implementation of novel local spatial access measures.Data Sources/Study SettingEmergency department admissions data are from four HealthLNK member hospitals in Chicago from 2007 to 2011. Primary care physician office and clinic locations were obtained from the American Medical Association and the City of Chicago.Study DesignMultilevel logit regression was used to model the relationship between individual- and neighborhood-level attributes and preventable ED use.Data Collection/Extraction MethodsEmergency department admissions data were classified based on the primary diagnosis for each encounter. Spatial access to care indices were generated in ArcGIS, and values were extracted at each ZIP code centroid to match patients' ZIP codes.Principal FindingsBeyond sociodemographic factors such as gender and race, patients living in medically underserved areas (MUAs) and areas with lower spatial access to primary care clinics had higher odds of preventable ED use.ConclusionsPreventable ED use can be associated with sociodemographic characteristics, as well as spatial access to primary care services. This study reveals potential for using local measures of spatial accessibility for preventable ED analyses.