Access to Emergency Care in the United States
Access to Emergency Care in the United States
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DOI：
10.1016/j.annemergmed.2008.11.016
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发表时间：
2009-08-01
影响因子：
6.2
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Carr, Brendan G.;Branas, Charles C.;Camargo, Carlos A., Jr.
研究目标：快速获得紧急服务对于急性心肌梗死、中风、败血症和重大创伤等紧急护理敏感情况至关重要。我们试图确定美国人口进入急诊科 (ED) 的情况。方法：使用美国国家急诊科清单来确定美国所有急诊科的位置、年度就诊量和教学状况。急诊室根据患者数量和教学状况分类为任何急诊室。使用经过验证的模型估算驾驶距离、驾驶速度和出院时间，并根据人口密度进行调整。通过对指定时间间隔内可以到达急诊室的人口进行求和来确定可及性。结果：总体而言，71% 的美国人口可以在 30 分钟内到达急诊室，98% 的人可以在 60 分钟内到达急诊室。前往教学医院的机会更加有限，16% 的人可以在 30 分钟内到达，44% 的人可以在 60 分钟内到达。农村州获得所有类型急诊的机会较低。结论：尽管大多数美国人口都可以获得急诊，但在获得急诊方面存在地区差异，特别是农村地区。未来的工作应该衡量获得紧急服务与紧急护理敏感状况的结果之间的关系。应探索建立区域化的急救服务体系。 [安紧急医学。 2009；54：261-269。]
Study objective: Rapid access to emergency services is essential for emergency care-sensitive conditions such as acute myocardial infarction, stroke, sepsis, and major trauma. We seek to determine US population access to an emergency department (ED).Methods: The National Emergency Department Inventories-USA was used to identify the location, annual visit volume, and teaching status of all EDs in the United States. EDs were categorized as any ED, by patient volume, and by teaching status. Driving distances, driving speeds, and out-of-hospital times were estimated with validated models and adjusted for population density. Access was determined by summing the population that could reach an ED within the specified intervals.Results: Overall, 71% of the US population has access to an ED within 30 minutes, and 98% has access within 60 minutes. Access to teaching hospitals was more limited, with 16% having access within 30 minutes and 44% within 60 minutes. Rural states had lower access to all types of EDs.Conclusion: Although the majority of the US population has access to an ED, there are regional disparities in ED access, especially by rurality. Future efforts should measure the relationship between access to emergency services and outcomes for emergency care-sensitive conditions. The development of a regionalized emergency care delivery system should be explored. [Ann Emerg Med. 2009;54:261-269.]