USE OF HEALTH-SERVICES BY AFRICAN-AMERICAN CHILDREN WITH ASTHMA ON MEDICAID
USE OF HEALTH-SERVICES BY AFRICAN-AMERICAN CHILDREN WITH ASTHMA ON MEDICAID
复制标题
DOI：
10.1001/jama.274.6.469
复制
发表时间：
1995-08-09
影响因子：
120.7
通讯作者：
KOEPSELL, TD
中科院分区：
文献类型：
--
作者：
LOZANO, P;CONNELL, FA;KOEPSELL, TD
目的.-确定非裔美国哮喘儿童是否比具有相似保险范围和家庭收入的白人儿童使用更多的急诊室 (ED) 和住院医疗服务，而使用更少的预防性服务。设计.-使用医疗补助索赔数据进行历史队列研究，背景.-对华盛顿州西雅图-塔科马大都市区 3 至 17 岁有受抚养儿童的家庭的援助。患者。-所有 576 名非裔美国儿童和 1369 名白人1988 年 6 月至 1992 年 12 月期间接受哮喘服务的儿童。主要结果指标。-利用哮喘服务（急诊室、住院、就诊和药房）和儿童保健服务以及相关的医疗补助报销。结果。-非裔美国儿童比白人儿童更有可能因哮喘就诊或住院；调整后的比值比 (OR) 分别为 1.70（95% 置信区间 [CI]，1.34 至 2.15）和 1.42（95% CI，1.03 至 1.96），非洲裔美国儿童因哮喘就诊的可能性较小；调整后的 OR 为 0.48（95% CI，0.26 至 0.85）。两组患者服用哮喘药物处方并进行儿童健康检查的可能性相似。非裔美国儿童的人均哮喘服务费用高出 24%：每儿童年 436 美元 vs 350 美元。结论：使用医疗补助的非裔美国儿童（与白人儿童相比）使用急诊室和住院治疗哮喘服务的比例较高，这不能完全用贫困或健康保险不足来解释。此外，这些儿童因哮喘就诊的次数似乎极少，这表明哮喘预防服务的使用效果不佳。相比之下，两组儿童健康检查的使用情况相当，表明问题可能并不在于获得一般护理，但在非洲裔美国儿童中成功管理哮喘等慢性病方面可能存在具体问题。
Objective.-To determine whether African-American children with asthma use more emergency department (ED) and inpatient medical services and fewer preventive services than white children with similar insurance coverage and family income.Design.-Historical cohort study using Medicaid claims data,Setting.-Aid to Families With Dependent Children enrollees aged 3 through 17 years in the Seattle-Tacoma, Wash, metropolitan area.Patients.-All 576 African-American children and 1369 white children receiving services for asthma between June 1988 and December 1992.Main Outcome Measures.-Utilization of asthma services (ED, inpatient, office visits, and pharmacy) and well-child services and associated Medicaid reimbursements,Results.-African-American children were more likely than white children to make ED visits or to be hospitalized for asthma; adjusted odds ratios (ORs) were 1.70 (95% confidence interval [CI], 1.34 to 2.15) and 1.42 (95% CI, 1.03 to 1.96), respectively, African-American children were less likely to have made an office visit for asthma; the adjusted OR was 0.48 (95% CI, 0.26 to 0.85). The two groups were similarly likely to have filled a prescription for an asthma medication and to have made a well-child visit. Per capita payments for asthma services were 24% higher for African-American children: $436 vs $350 per child-year.Conclusions.-Higher use of ED and inpatient services for asthma among African-American children using Medicaid (compared with white children) cannot be fully explained by poverty or inadequate health insurance. Furthermore, these children appear to make disproportionately few office visits for asthma, suggesting suboptimal use of preventive services for asthma. In contrast, the comparable use of well-child visits in the two groups suggests the problem may not be in access to care in general, but there may be specific problems in the successful management of chronic diseases such as asthma among African-American children.