National Profile of Nonemergent Pediatric Emergency Department Visits
National Profile of Nonemergent Pediatric Emergency Department Visits
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DOI：
10.1542/peds.2009-0544
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发表时间：
2010-03-01
期刊：
影响因子：
8
通讯作者：
Chen, Alex Y.
中科院分区：
文献类型：
--
作者：
Ben-Isaac, Eyal;Schrager, Sheree M.;Chen, Alex Y.
目的：急诊室（艾德）拥挤妨碍了卫生服务的有效利用，并影响了质量。因非紧急健康问题而使用艾德的患者可能不必要地拥挤在艾德服务中。在这篇文章中，我们描述了在美国的儿科患者谁使用ED非紧急visits.METHODS的特点：我们分析了2002-2005年的医疗支出面板调查的数据。医疗支出小组调查由医疗保健研究和质量局进行，由美国平民非机构化人口的全国代表性样本组成。我们的研究样本包括5512人-年的观察。我们只纳入了出生至17岁的儿童的艾德就诊，并指定了国际疾病分类第九次修订版，临床修改诊断代码。我们的多变量logistic模型的主要因变量是非紧急艾德使用，这是通过使用纽约大学ED分类算法构建的。自变量来自Andersen的卫生服务Utilization.RESULTS行为模型：我们发现，从2002年至2005年，一个全国代表性的美国儿童从出生到17岁的样本使用ED各种非紧急或初级保健可治疗的诊断。总体而言，来自高收入家庭的儿童的艾德支出高于来自低收入家庭的儿童。有私人保险的儿童的艾德总支出高于有公共保险或无保险的儿童，但无保险的儿童有最高的自付支出。我们发现，与年龄较大的儿童相比，从出生到2岁的儿童不太可能使用艾德进行非紧急诊断（比值比[OR]：0.13; P <0.01）。非西班牙裔黑人儿童也不太可能使用的艾德非紧急诊断（OR：0.40; P = .03）比非西班牙裔白色childhes.CONCLUSION：儿童的社会人口特征是预测非紧急使用的艾德服务。儿科2010;125：454-459
OBJECTIVE: Emergency department (ED) crowding prevents the efficient and effective use of health services and compromises quality. Patients who use the ED for nonemergent health concerns may unnecessarily crowd ED services. In this article we describe characteristics of pediatric patients in the United States who use EDs for nonemergent visits.METHODS: We analyzed data from the 2002-2005 Medical Expenditure Panel Survey. The Medical Expenditure Panel Survey is conducted by the Agency for Healthcare Research and Quality and consists of a nationally representative sample of the civilian noninstitutionalized population of the United States. Our study sample consisted of 5512 person-years of observation. We included only ED visits for children from birth to 17 years of age with a specified International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. The main dependent variable for our multivariate logistic model was nonemergent ED use, which was constructed by using the New York University ED-classification algorithm. Independent variables were derived from Andersen's Behavioral Model of Health Services Utilization.RESULTS: We found that from 2002 to 2005, a nationally representative sample of US children from birth to 17 years of age used EDs for various nonemergent or primary care-treatable diagnoses. Overall, children from higher-income families had higher ED expenditures than children from lower-income families. Children with private insurance had higher total ED expenditures than publicly insured or uninsured children, but uninsured children had the highest out-of-pocket expenditures. We found that children from birth to 2 years of age were less likely to use the ED for nonemergent diagnoses (odds ratio [OR]: 0.13; P < .01) compared with older children. Non-Hispanic black children were also less likely to use the ED for nonemergent diagnoses (OR: 0.40; P = .03) than were non-Hispanic white children.CONCLUSION: Children's sociodemographic characteristics were predictors of nonemergent use of ED services. Pediatrics 2010;125:454-459