Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions - A new approach
Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions - A new approach
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DOI：
10.1097/00005650-200212000-00013
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发表时间：
2002-12-01
期刊：
影响因子：
3
通讯作者：
Burstin, H
中科院分区：
文献类型：
--
作者：
Basu, J;Friedman, B;Burstin, H
客观的。与其他类型的住院治疗相比，旨在检查初级保健可用性、HMO 注册以及其他人员和地点变量与纽约州成年人可能可预防的住院治疗之间的关联。数据来源/研究背景。使用由医疗保健研究和质量局维护的医疗保健成本和利用项目 (HCUP) 的 1995 年全州出院档案，统计在纽约州或三个相邻州（新泽西州、宾夕法尼亚州或康涅狄格州）住院的 20-64 岁纽约居民的出院情况。多项 Logit 模型使用个体放电作为分析单位。将 ACS 入院与标记入院（紧急但非 ACS）和转诊敏感手术（更具自由裁量权）进行比较，控制疾病的严重程度。主要发现。与标记入院相比，较高的初级保健密度与较低的 ACS 入院可能性相关，并且不会增加转诊敏感入院。该研究还支持了这样的假设：与其他参保成年人相比，私人 HMO 参保者入院 ACS 的可能性较小。即使与其他 Medicaid 参保者相比，Medicaid HMO 参保者也没有发现这一结果。结论。与政策相关的一个关键结果是人均初级保健医生与 ACS 入院可能性呈负相关，而没有通过转诊敏感入院与资源成本抵消相关性。该方法允许通过与其他特定类型的入院对比来检查个人和地区变量对一种类型的入院 (ACS) 的可能影响。当使用关于个体患者和多个时间段的更好数据时，可以通过多种方式对特定人群加强这种类型的分析。
OBJECTIVE. To examine the association of primary care availability, HMO enrollment, and other person and location variables with potentially preventable hospitalization for adults in New York State, compared with other types of hospitalization.DATA SOURCES/STUDY SETTING. Hospital discharges of New York residents in the age group 20-64 hospitalized either in New York or in three contiguous states: New Jersey, Pennsylvania, or Connecticut using 1995 state-wide discharge files from the Health care Cost and Utilization Project (HCUP) maintained by the Agency for Health care Research and Quality.STUDY DESIGN. A multinomial logit model uses the individual discharge as the unit of analysis. ACS admissions are compared with marker admissions (urgent but non-ACS) and referral sensitive surgeries (more discretionary), controlling for severity of illness.PRINCIPAL FINDINGS. Higher primary care density was associated with a lower likelihood of ACS admission, compared with marker admissions, without increasing referral-sensitive admissions. The study also supports the hypothesis of ACS admissions being less likely for private HMO enrollees than for other insured adults. This result was not found for Medicaid HMO enrollees, even by comparison to other Medicaid enrollees.CONCLUSIONS. A key policy-relevant result is the negative association of primary care physicians per capita with the likelihood of ACS admissions, without an offsetting association with resource costs via referral-sensitive admissions. The method allowed for examining the possible effects of personal and area variables on one type of hospital admission (ACS) by contrast with other specific types of admissions. This type of analysis could be strengthened in several ways for a defined population when better data on individual patients and several time periods are used.