How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California
How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California
复制标题
DOI：
10.1136/bmjopen-2017-020897
复制
发表时间：
2018-06-01
期刊：
影响因子：
2.9
通讯作者：
Hsia, Renee Y.
中科院分区：
文献类型：
--
作者：
McConville, Shannon;Mooney, Alyssa C.;Hsia, Renee Y.
目的 评估 2014 年加州有和没有刑事司法接触者的急诊室 (ED) 使用模式，比较 ED 使用、就诊频率、诊断和保险范围的变化。设计回顾性横断面研究。设置分析包括使用 2014 年全州范围内所有 ED 就诊数据对加州所有持证医院进行 ED 就诊。参与者 研究参与者包括 3 757 870 名至少进行过一次 ED 就诊的非老年成年 ED 患者2014 年。主要和次要结果指标 我们评估了那些有刑事司法接触的患者（被惩教机构收治或从急诊室出院的患者）以及在急诊就诊期间没有记录刑事司法接触记录的患者的急诊就诊模式和特征。结果 有刑事司法接触的急诊患者经常使用急诊的比例较高（27.2% vs 9.4%），因急诊就诊导致住院的风险较高（26.6% vs 9.4%）。与急诊就诊期间没有记录刑事司法接触记录的患者相比，该患者的精神健康状况患病率更高（52.8% vs 30.4%）。前10名中，刑事司法接触患者的原发诊断有4例与行为健康状况相关，占该人群所有原发诊断的19.0%。相比之下，在没有观察到刑事司法接触的 ED 患者中，前 10 名主要诊断中不存在行为健康问题。尽管疾病负担很高，但与没有刑事司法接触的人相比，缺乏健康保险覆盖的情况更常见（41.3% vs 14.1%）。 结论 鉴于大部分有刑事司法接触的急诊科患者都是患有严重心理健康问题的频繁使用者，加州医疗补助计划目前为识别需要协调服务的个人所做的努力可以减少该群体中昂贵的急诊室使用率。
Objective To assess the patterns of emergency department (ED) utilisation among those with and without criminal justice contact in California in 2014, comparing variation in ED use, visit frequency, diagnoses and insurance coverage.Design Retrospective, cross-sectional study.Setting Analyses included ED visits to all licensed hospitals in California using statewide data on all ED encounters in 2014.Participants Study participants included 3 757 870 non elderly adult ED patients who made at least one ED visit in 2014.Primary and secondary outcome measures We assessed the patterns and characteristics of ED visits among those with criminal justice contact-patients who were either admitted to or discharged from the ED by a correctional institution-with patients who did not have criminal justice contact recorded during an ED visit.Results ED patients with criminal justice contact had higher proportions of frequent ED users (27.2% vs 9.4%), were at higher risk of an ED visit resulting in hospitalisation (26.6% vs 15.2%) and had higher prevalence of mental health conditions (52.8% vs 30.4%) compared with patients with no criminal justice contact recorded during an ED visit. Of the top 10, four primary diagnoses among patients with criminal justice contact were related to behavioural health conditions, accounting for 19.0% of all primary diagnoses in this population. In contrast, behavioural health conditions were absent from the top 10 primary diagnoses in ED patients with no observed criminal justice contact. Despite a high burden of disease, a lack of health insurance coverage was more common among those with criminal justice contact than those without (41.3% vs 14.1%).Conclusions Given that a large proportion of ED patients with criminal justice contact are frequent users with considerable mental health conditions, current efforts in California's Medicaid programme to identify individuals in need of coordinated services could reduce costly ED utilisation among this group.