Factors influencing inappropriate use of ED visits among type 2 diabetics in an evidence-based management programme
Factors influencing inappropriate use of ED visits among type 2 diabetics in an evidence-based management programme
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DOI：
10.1111/j.1365-2753.2009.01248.x
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发表时间：
2010-12-01
影响因子：
2.4
通讯作者：
Horswell, Ronald
中科院分区：
文献类型：
--
作者：
Chiou, Shang-Jyh;Campbell, Claudia;Horswell, Ronald
目的本研究分析了循证管理计划下 2 型糖尿病患者对急诊科 (ED) 服务的不当使用。方法使用 1999-2006 年路易斯安那州卫生保健服务部 (HCSD) 八家公立医院急诊科就诊的数据库，对路易斯安那州未参保患者和其他患者进行急诊科就诊，我们将紧急急诊科就诊称为适当，不太紧急就诊称为不适当。排除周末急诊就诊，使用广义估计方程方法对 8596 名患者的 17 458 例紧急就诊和 22 395 例次紧急就诊进行了分析。结果与非裔美国人相比，白人不当使用急诊室的可能性低 0.82 倍（95% CI：0.751-0.889）。拥有商业保险、医疗补助和医疗保险的患者比没有保险的患者更不恰当地使用急诊室，比值比分别为 1.28、1.32 和 1.28。前一年住院的患者因不当行为的可能性降低了 0.84 倍 (95% CI: 1.08-1.31)。较大医院的患者更不恰当地使用急诊室，比值比为 1.44（95% CI：1.32-1.56）。结论该研究表明，在循证管理计划中糖尿病患者中不恰当使用急诊室的情况更可能发生在非裔美国人、有保险的患者和在较大医院寻求治疗的患者中。加强定期使用诊所服务进行糖尿病管理、在非工作时间提供诊所服务以及让健康计划参与为更适当地使用急诊室提供激励措施可能会减少不适当的急诊就诊。值得注意的是，来自 HCSD 的未投保糖尿病患者是 ED 的更有效使用者。
ObjectThis study analyses inappropriate use of emergency department (ED) services among type 2 diabetics under an evidence-based management programme.MethodsUsing 1999-2006 databases of Louisiana Health Care Services Division (HCSD) eight public hospitals ED visits among the uninsured and other patients in Louisiana, we termed urgent ED visits appropriate and less-urgent visits inappropriate. Eliminating weekend ED visits, 17 458 urgent and 22 395 less-urgent visits by 8596 patients were analysed, using generalized estimating equation methods.ResultsCaucasians were 0.82 times (95% CI: 0.751-0.889) less likely to use the ED inappropriately compared with African Americans. Patients with commercial insurance, Medicaid and Medicare used the ED more inappropriately than uninsured, with odds ratios of 1.28, 1.32 and 1.28, respectively. Patients hospitalized the prior year were 0.84 times (95% CI: 1.08-1.31) less likely for inappropriate. Patients in larger hospitals used the ED more inappropriately, with an odds ratio of 1.44 (95% CI: 1.32-1.56).ConclusionsThe study suggests that inappropriate use of the ED among diabetic patients in an evidence-based management programme is more likely to occur among African American, patients with insurance coverage and those seeking care in larger hospitals. Reinforcing the regular use of clinic services for diabetes management, providing clinic access in off-hours, and engaging the health plans in providing incentives for more appropriate use of the ED might reduce inappropriate ED visits. Notably, uninsured patients with diabetes from HCSD were more efficient users of the ED.