The importance of examining movements within the US health care system: sequential logit modeling.
The importance of examining movements within the US health care system: sequential logit modeling.
复制标题
DOI：
10.1186/1472-6963-10-269
复制
发表时间：
2010-09-10
影响因子：
2.8
通讯作者：
Kim SS
中科院分区：
文献类型：
--
作者：
Lee C;Ayers SL;Kronenfeld JJ;Frimpong JA;Rivers PA;Kim SS
专科护理的利用可能不是一种离散的、孤立的行为，而是一种在卫生保健系统内连续运动的行为。尽管患者在使用专科护理之前可能经常去看他们的初级保健医生并接受转诊，但先前的研究低估了考虑这些顺序移动的重要性。样本包括6,772名18岁及以上的成年人，他们参加了由英联邦基金赞助的2001年护理质量差距调查。使用序贯Logit模型来考虑使用的所有阶段的变动：使用任何卫生服务(即，第一阶段)、感觉到需要专科护理(即，第二阶段)、以及利用专科护理(即，第三阶段)。在顺序Logit模型中，所有阶段都嵌套在前一个阶段中。性别、种族/族裔、教育和健康状况差对使用任何保健服务以及是否需要特殊护理有显著的解释作用，但在对特殊护理的利用方面不存在种族/族裔、性别和教育差异。在控制了任何卫生服务的使用和对专科护理的需求后，无法通过收入(AOR=1.334，CI=1.10~1.62)或医疗保险(不稳定保险：AOR=0.26，CI=0.14~0.48；无保险：AOR=0.12，CI=0.07~0.20)来支付专科护理的费用是专科医疗服务利用的显著障碍。使用序贯Logit模型来检查专科护理的利用情况，得到了在卫生保健系统内的所有阶段影响这些行为的利用行为和患者特征的详细表示。在控制了卫生保健系统内的连续流动之后，利用专科护理的最大障碍是无法支付费用，而种族、性别和教育差异则缩小到不显著的程度。这项研究的结果代表了美国人如何使用医疗保健系统，并更准确地揭示了美国医疗保健系统中的差异和不平等。
Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage. Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care. Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.
登录
查看更多内容
影响因子：
120.7
作者：
Grumbach, K;Selby, JV;Uratsu, C
通讯作者：
Uratsu, C
影响因子：
5.7
作者：
Johnson, RL;Saha, S;Cooper, LA
通讯作者：
Cooper, LA
影响因子：
120.7
作者：
KING, DE;LAHIRI, K
通讯作者：
LAHIRI, K
影响因子：
3
作者：
Cooper-Patrick, L;Gallo, JJ;Ford, DE
通讯作者：
Ford, DE
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM