Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of Hospital Emergency Departments in South Carolina: a population-based observational study.
Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of Hospital Emergency Departments in South Carolina: a population-based observational study.
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DOI：
10.1186/s12913-015-0864-6
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发表时间：
2015-05-16
影响因子：
2.8
通讯作者：
Hibbert J
中科院分区：
文献类型：
--
作者：
Chen BK;Cheng X;Bennett K;Hibbert J
医院急诊科（ED）的非紧急使用是一个有争议的话题。它被认为会增加医疗保健费用并降低质量，但也被认为是获得医疗保健机会不平等的一种症状。在本文中，我们调查了便利性（以到医院急诊科和最近的联邦合格医疗中心的旅行距离为代表）是否与非紧急急诊科的使用有关，以及在南卡罗来纳州弱势群体使用医院急诊科进行医疗护理的方式是否存在健康差异的证据。我们的数据包括2005年至2010年间南卡罗来纳州预算控制委员会和研究与统计办公室的6592501次ED访问。南卡罗来纳居民的所有急诊科就诊，包括未隐藏的变量和未遗漏的紧急措施，约占所有急诊科就诊的76%，均用于分析。我们使用多变量线性回归来估计(1)出行距离与可观察到的社会人口特征之间的相关性；(2)非紧急ED使用或频繁使用ED的度量，如纽约大学ED算法所定义的。拥有商业私人保险的患者、自费患者和其他支付来源的患者使用非紧急急诊科的次数越少，急诊科设施离患者家庭地址越远。在南卡罗来纳州，弱势群体，特别是非裔美国人和医疗补助患者，非紧急急诊科得分较高，并且由于非紧急和紧急原因更频繁地使用急诊科。与此同时，非裔美国人去医院急诊科就诊的医疗状况具有更高的初级保健可预防得分。与普遍的看法相反，在南卡罗来纳州私人保险患者和自费患者中，前往医院急诊科的便利（就旅行距离而言）与较不紧急的急诊科使用相关，但与公共保险患者无关。从非裔美国患者使用医院急诊科治疗初级保健可治疗的疾病，同时经历更频繁和更严重的初级保健可预防的疾病的情况来看，获得初级保健的不平等似乎存在。本文的在线版本（doi:10.1186/s12913-015-0864-6）包含补充材料，可供授权用户使用。
Nonurgent use of hospital emergency departments (ED) is a controversial topic. It is thought to increase healthcare costs and reduce quality, but is also considered a symptom of unequal access to health care. In this article, we investigate whether convenience (as proxied by travel distances to the hospital ED and to the closest federally qualified health center) is associated with nonurgent ED use, and whether evidence of health disparities exist in the way vulnerable populations use the hospital ED for medical care in South Carolina. Our data includes 6,592,501 ED visits in South Carolina between 2005 and 2010 from the South Carolina Budget Control Board and Office of Research and Statistics. All ED visits by South Carolina residents with unmasked variables and nonmissing urgency measures, or approximately 76 % of all ED visits, are used in the analysis. We perform multivariable linear regressions to estimate correlations between (1) travel distances and observable sociodemographic characteristics and (2) measures of nonurgent ED use or frequent nonurgent ED use, as defined by the New York University ED Algorithm. Patients with commercial private insurance, self-pay patients, and patients with other payment sources have lower measures of nonurgent ED use the further away the ED facility is from the patients’ home address. Vulnerable populations, particularly African American and Medicaid patients, have higher measures of nonurgent ED scores, and are more frequent users of the ED for both nonurgent and urgent reasons in South Carolina. At the same time, African Americans visit the hospital ED for medical conditions with higher primary care-preventable scores. Contrary to popular belief, convenient access (in terms of travel distances) to hospital ED is correlated with less-urgent ED use among privately insured patients and self-pay patients in South Carolina, but not publicly insured patients. Unequal access to primary care appears to exist, as suggested by African American patients’ use of the hospital ED for primary care-treatable conditions while experiencing more frequent and more severe primary care-preventable conditions. The online version of this article (doi:10.1186/s12913-015-0864-6) contains supplementary material, which is available to authorized users.
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影响因子：
6.2
作者：
BUESCHING, DP;JABLONOWSKI, A;PORTER, R
通讯作者：
PORTER, R
DOI：
10.1111/j.1365-2753.2009.01248.x
发表时间：
2010-12-01
影响因子：
2.4
作者：
Chiou, Shang-Jyh;Campbell, Claudia;Horswell, Ronald
通讯作者：
Horswell, Ronald
影响因子：
3
作者：
Johnson, Pamela Jo;Ghildayal, Neha;Hokanson, Jon S.
通讯作者：
Hokanson, Jon S.
影响因子：
2.3
作者：
Downey, La Vonne A.
通讯作者：
Downey, La Vonne A.
影响因子：
3.4
作者：
Gresenz, Carole Roan;Rogowski, Jeannette;Escarce, Jose J.
通讯作者：
Escarce, Jose J.