Hospital Proximity and Emergency Department Use among Assisted Living Residents.
Hospital Proximity and Emergency Department Use among Assisted Living Residents.
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辅助生活居民的医院距离和急诊室使用情况。
DOI：
10.1016/j.jamda.2023.05.002
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发表时间：
2023
影响因子：
7.6
通讯作者：
Temkin-Greener,Helena
中科院分区：
文献类型：
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作者：
McGarry,BrianE;Mao,Yunjiao;Nelson,DallasL;Temkin-Greener,Helena
目的探讨AL社区与最近医院的距离与居民急诊科使用率的关系。我们假设，当到达急诊科更方便时，通过更短的距离来衡量，辅助生活（AL）到急诊科的转移更常见，特别是对于非紧急情况。设计回顾性队列研究，主要关注每个AL和最近医院之间的距离。背景和参与者2018-2019年医疗保险索赔用于确定居住在AL社区的年龄≥55岁的按服务收费的医疗保险受益人。方法研究的主要结局是急诊科就诊率，分为导致住院和不导致住院的两类（即急诊科治疗出院就诊）。根据纽约大学ED算法，ED治疗和出院的访问进一步分类为(1)非紧急；(2)急诊、初级保健可治疗；(3)急诊，不能进行初级保健治疗；(4)伤害相关。采用调整居民特征和医院转诊区域固定效应的线性回归模型来估计到最近医院的距离与AL住院急诊科使用率的关系。结果来自16,514个AL社区的540,944个居民年中，到最近医院的中位距离为2.5英里。调整后，到最近医院的距离增加一倍，每1000个居民年减少43.5次急诊科治疗和出院就诊（95% CI - 53.1, - 33.7），急诊科就诊导致住院的比率没有显著差异。在急诊科治疗后出院的就诊中，距离增加一倍与归类为非急诊的就诊减少3.0% （95% CI - 4.1, - 1.9）和归类为急诊而非初级保健可治疗的就诊减少1.6% （95% CI - 2.4%, - 0.8%）相关。结论和意义到最近医院的距离是AL居民ED使用率的一个重要预测指标，特别是对于那些可能可以避免的就诊。人工智能设施可能依赖附近的急诊室为居民提供非紧急初级护理，这可能使居民面临医源性事件的风险，并产生浪费的医疗保险支出。
ObjectivesTo examine the relationship between AL communities' distance to the nearest hospital and residents’ rates of emergency department (ED) use. We hypothesize that when access to an ED is more convenient, as measured by a shorter distance, assisted living (AL)-to-ED transfers are more common, particularly for nonemergent conditions.DesignRetrospective cohort study, where the main exposure of interest was the distance between each AL and the nearest hospital.Setting and Participants2018-2019 Medicare claims were used to identify fee-for-service Medicare beneficiaries aged ≥55 years residing in AL communities.MethodsThe primary outcome of interest was ED visit rates, classified into those that resulted in an inpatient hospital admission and those that did not (ie, ED treat-and-release visits). ED treat-and-release visits were further classified, based on the NYU ED Algorithm, as (1) nonemergent; (2) emergent, primary care treatable; (3) emergent, not primary care treatable; and (4) injury-related. Linear regression models adjusting for resident characteristics and hospital referral region fixed effects were used to estimate the relationship between distance to the nearest hospital and AL resident ED use rates.ResultsAmong 540,944 resident-years from 16,514 AL communities, the median distance to the nearest hospital was 2.5 miles. After adjustment, a doubling of distance to the nearest hospital was associated with 43.5 fewer ED treat-and-release visits per 1000 resident years (95% CI −53.1, −33.7) and no significant difference in the rate of ED visits resulting in an inpatient admission. Among ED treat-and-release visits, a doubling of distance was associated with a 3.0% (95% CI −4.1, −1.9) decline in visits classified as nonemergent, and a 1.6% (95% CI −2.4%, −0.8%) decline in visits classified as emergent, not primary care treatable.Conclusions and ImplicationsDistance to the nearest hospital is an important predictor of ED use rates among AL residents, particularly for visits that are potentially avoidable. AL facilities may rely on nearby EDs to provide nonemergent primary care to residents, potentially placing residents at risk of iatrogenic events and generating wasteful Medicare spending.