Comparing Preventable Acute Care Use of Rural Versus Urban Americans: an Observational Study of National Rates During 2008-2017.
Comparing Preventable Acute Care Use of Rural Versus Urban Americans: an Observational Study of National Rates During 2008-2017.
复制标题
比较农村和城市美国人的可预防急性护理使用情况：2008-2017 年全国比率的观察性研究。
DOI：
10.1007/s11606-020-06532-4
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发表时间：
2021
影响因子：
5.7
通讯作者：
JoyntMaddox,KarenE
中科院分区：
文献类型：
--
作者：
Johnston,KentonJ;Wen,Hefei;Kotwal,Ameya;JoyntMaddox,KarenE
背景美国农村人比城市人获得医疗保健的机会少。可预防的急诊护理使用是未满足的门诊医疗保健需求的标志，但对农村和城市地区的这种使用如何随着时间的推移而有所不同知之甚少。比较过去十年农村与城市居民的可预防急诊科（艾德）就诊率和住院率。设计观察性研究，使用经验证的算法计算每100人的年龄性别调整率，000人可预防的艾德就诊和住院。评估了农村与城市居民的总体、年度和特定疾病发生率的差异，并使用线性回归评估了10年的趋势。设置全国急诊科样本、全国住院患者样本和美国人口普查，2008- 2017年。美国成年人，年平均2.413亿人。测量可解释的艾德就诊和住院情况。结果与城市居民相比，2008年，农村居民可预防的艾德就诊率高出45%（每10万人中3003例vs. 2070例，调整后差异[AD]：933; 95% CI：928-938），2017年可预防的艾德就诊率高出44%（3911 vs 2708/100，000，AD：1202; 95% CI：1196-1208）。2008年，农村居民可预防性住院率高出26%（每10万人中有2104人比1666人，AD：439; 95% CI：434-443），2017年高出13%（每10万人中有1634人比1440人，AD：194; 95% CI：190-199）。与城市居民相比，农村居民可接受的艾德就诊的绝对值增加更多，但百分比增加相似（30% vs. 31%），因为农村居民的基线水平较高。可预防的住院率以更快的速度下降（22%比14%）在农村与城市residents.LimitationsObservational study; unable to induce cause.ConclusionsRural差距在急性护理使用缩小可预防的住院治疗，但一直坚持所有可预防的急性护理使用，这表明未满足的需求，高质量的门诊护理在农村地区。
BackgroundRural Americans have less access to care than urban Americans. Preventable acute care use is a marker of unmet ambulatory healthcare needs, but little is known about how such utilization has differed between rural and urban areas over time.ObjectiveCompare preventable emergency department (ED) visit and hospitalization rates among rural versus urban residents over the past decade.DesignObservational study using a validated algorithm to compute age-sex-adjusted rates per 100,000 individuals of preventable ED visits and hospitalizations. Differences in overall, annual, and condition-specific rates for rural versus urban residents were assessed and linear regression was used to assess 10-year trends.SettingNationwide Emergency Department Sample, National Inpatient Sample, and US Census, 2008–2017.ParticipantsUS adults, an annual average of 241.3 million individuals.MeasurementsPreventable ED visits and hospitalizations.ResultsCompared to urban residents, rural residents had 45% higher rates of preventable ED visits in 2008 (3003 vs. 2070 per 100,000, adjusted difference [AD]: 933; 95% CI: 928–938) and 44% higher rates of preventable ED visits in 2017 (3911 vs. 2708 per 100,000, AD: 1202; 95% CI: 1196–1208). Rural residents had 26% higher rates of preventable hospitalizations in 2008 (2104 vs. 1666 per 100,000, AD: 439; 95% CI: 434–443) and 13% higher rates in 2017 (1634 vs. 1440 per 100,000, AD: 194; 95% CI: 190–199). Preventable ED visits increased more in absolute terms in rural versus urban residents, but the percentage increase was similar (30% vs. 31%) because rural residents started at a higher baseline. Preventable hospitalizations decreased at a faster rate (22% vs. 14%) among rural versus urban residents.LimitationsObservational study; unable to infer causality.ConclusionsRural disparities in acute care use are narrowing for preventable hospitalizations but have persisted for all preventable acute care use, suggesting unmet demand for high-quality ambulatory care in rural areas.