Are preventable hospitalizations sensitive to changes in access to primary care? The case of the Oregon Health Plan
Are preventable hospitalizations sensitive to changes in access to primary care? The case of the Oregon Health Plan
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DOI：
10.1097/mlr.0b013e318053717c
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发表时间：
2007-08-01
期刊：
影响因子：
3
通讯作者：
Bindman, Andrew B.
中科院分区：
文献类型：
--
作者：
Saha, Somnath;Solotaroff, Rachel;Bindman, Andrew B.
目的：为了研究是否可预防的住院（PH）率是敏感的政策，旨在改善访问的影响，如俄勒冈州健康计划（OHP），扩大医疗补助覆盖范围的所有成年人的收入低于联邦贫困水平。研究设计：我们进行了一个回顾性的，时间序列分析PH率在俄勒冈州从1990年至2000年。我们计算了医疗补助+无保险人群的门诊护理敏感条件的住院率，并将1990年至1993年（OHP实施前）的平均年住院率与1995年至2000年（OHP实施后）的平均年住院率进行了比较。我们比较了医疗补助+无保险组PH率随时间的变化与非医疗补助保险人群的变化。我们标准化率的年龄和性别，并使用logistic回归模型来比较rate.Results：与我们的假设相反，在医疗补助+无保险人口的年度PH率增加后的资格扩大，从平均46.1至54.9每10,000人。与非医疗补助保险人群相比，这一增长是显着的，非医疗补助保险人群的年PH率略有下降，从每10，000人26.9降至26.1（P < 0.001，调整年龄，性别和不可预防的住院率后）。在整体PH率的医疗补助+无保险人口的增加可以解释为PH率的增加，为新投保group.Conclusions：我们的研究结果表明，PH率可能会有所不同，不仅与获得初级保健（反向），但也与获得医院护理（直接）。使用PH率作为卫生保健可及性的标志应考虑到这些双重影响。可用数据的局限性也可能导致与医疗保健获取无关的PH率的感知变化。
Objective: To examine whether preventable hospitalization (PH) rates are sensitive to the impact of policies aimed at improving access, such as the Oregon Health Plan (OHP), which expanded Medicaid coverage to all adults with incomes under the federal poverty level.Study Design: We conducted a retrospective, time series analysis of PH rates in Oregon from 1990 to 2000. We calculated hospitalization rates for ambulatory-care sensitive conditions for the Medicaid + uninsured population and compared average annual rates from 1990 to 1993 (pre-OHP implementation) to those from 1995 to 2000 (post-OHP implementation). We compared changes in PH rates over time in the Medicaid + uninsured group to changes in the nonMedicaid insured population. We standardized rates by age and sex and used logistic regression models to compare rates.Results: Contrary to our hypothesis, annual PH rates in the Medicaid + uninsured population increased after the eligibility expansion, from an average of 46.1 to 54.9 per 10,000 persons. This rise was significant compared with the non-Medicaid insured population, who experienced a slight decline in annual PH rates, from 26.9 to 26.1 per 10,000 (P < 0.001, after adjusting for age, sex, and rates of unpreventable hospitalizations). The increase in overall PH rates for the Medicaid + uninsured population can be explained by an increase in PH rates for the newly insured group.Conclusions: Our results suggest that PH rates may vary not only with access to primary care (inversely) but also with access to hospital care (directly). The use of PH rates as a marker of health care access should take into account these dual influences. Limita tions in available data may also contribute to perceived variation in PH rates unrelated to health care access.