RATES OF AVOIDABLE HOSPITALIZATION BY INSURANCE STATUS IN MASSACHUSETTS AND MARYLAND
RATES OF AVOIDABLE HOSPITALIZATION BY INSURANCE STATUS IN MASSACHUSETTS AND MARYLAND
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DOI：
10.1001/jama.268.17.2388
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发表时间：
1992-11-04
影响因子：
120.7
通讯作者：
EPSTEIN, AM
中科院分区：
文献类型：
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作者：
WEISSMAN, JS;GATSONIS, C;EPSTEIN, AM
目的：-确定未参保和医疗补助的患者是否比有保险的患者有更高的可避免住院率。设计-我们使用1987年计算机化的医院出院数据来选择住院患者的横断面样本。来自当前人口调查的人口估计被用来估计入院率，年龄和性别标准化。设置。-马萨诸塞州和马里兰的非联邦急性护理医院。患者。-所有65岁以下的未参保、私人参保或由医疗补助计划参保的患者。产科和精神疾病的住院治疗被排除在外。主要结果衡量标准。-由医生小组确定的12种可避免的住院条件(AHC)的相对入院风险。结果：未参保和医疗补助的患者比有保险的患者更有可能因AHC住院。在马萨诸塞州12个单独的AHC中有10个没有保险的患者的比率明显高于私人保险的患者，在马里兰州12个AHC中有5个AHC的比率显著高于私人保险的患者。在对基线利用率进行调整后，马萨诸塞州12所AHC中的10所和马里兰州12所AHC中的7所的结果具有统计学意义。对于医疗补助患者，调整前每个州所有AHC的比率明显高于私人保险患者，每个州12个AHC中的9个和7个在对基线利用率进行调整后分别是9个和7个。结论-我们的研究结果表明，没有保险或有医疗补助覆盖范围的患者，对于通常可以出院治疗或完全可以避免的疾病，住院率更高。我们的方法可能对选定的患者群体的获取和护理质量的常规监测有用。
Objective.-To determine whether uninsured and Medicaid patients have higher rates of avoidable hospitalizations than do insured patients.Design.-We used 1987 computerized hospital discharge data to select a cross-sectional sample of hospitalized patients. Population estimates from the Current Population Survey were used to estimate rates of admission, standardized for age and sex.Setting.-Nonfederal acute care hospitals in Massachusetts and Maryland.Patients.-All patients under 65 years of age who were uninsured, privately insured, or insured by Medicaid. Hospitalizations for obstetric and psychiatric conditions were excluded.Main Outcome Measures.-Relative risk of admission for 12 avoidable hospital conditions (AHCs) identified by a physician panel.Results.-Uninsured and Medicaid patients were more likely than insured patients to be hospitalized for AHCs. Rates for uninsured patients were significantly greater than for privately insured patients in Massachusetts for 10 of 12 individual AHCs, and in Maryland for five of 12 AHCs. After adjustment for baseline utilization, the results were statistically significant for 10 of 12 AHCs in Massachusetts and seven of 12 AHCs in Maryland. For Medicaid patients, rates were significantly greater than for privately insured patients for all AHCs in each state before adjustment, and for nine of 12 and seven of 12 AHCs in each state, respectively, after adjustment for baseline utilization.Conclusion.-Our findings suggest that patients who are uninsured or who have Medicaid coverage have higher rates of hospitalization for conditions that can often be treated out of hospital or avoided altogether. Our approach is potentially useful for routine monitoring of access and quality of care for selected groups of patients.