Disparities in Emergency Department Wait Times for Acute Gastrointestinal Illnesses: Results From the National Hospital Ambulatory Medical Care Survey, 1997-2006
Disparities in Emergency Department Wait Times for Acute Gastrointestinal Illnesses: Results From the National Hospital Ambulatory Medical Care Survey, 1997-2006
复制标题
DOI：
10.1038/ajg.2009.189
复制
发表时间：
2009-07-01
影响因子：
9.8
通讯作者：
Conwell, Darwin L.
中科院分区：
文献类型：
--
作者：
Wu, Bechien U.;Banks, Peter A.;Conwell, Darwin L.
目的：（一）本研究的目的是报告等待时间访问美国急诊科（ED）的急性胃肠道疾病，（二）以确定是否存在种族/民族差异的等待时间，及（三）表征相关因素延迟在医生assessment.METHODS：我们分析了数据从全国医院门诊医疗服务调查（NHAMCS）从1997年至2006年。我们研究了急性胰腺炎、阑尾炎、胆囊炎和上消化道出血（UGIH）的等待时间。诊断是基于国际疾病分类，第九次修订，临床修改。人种/种族类别定义为非西班牙裔白色（NHW）、非西班牙裔黑人和西班牙裔白色（HW）。等待时间按人种/种族组和研究年份分层。我们评估了种族/民族和相对于分诊分配的延迟频率之间的关联。多变量Logistic回归估计的影响，年龄，性别，支付状况，和地理上的等待时间。结果：估计有160万艾德访问急性胰腺炎，220万访问阑尾炎，120万访问胆囊炎，和390万访问UGIH在NHAMCS调查在研究期间。平均等待时间从48分钟（急性胰腺炎）到61分钟（胆囊炎）不等。我们发现24%的病例延迟了临床评估。在多变量分析中，种族/民族是等待时间增加的独立预测因素。HW等待更长的时间，有更高的频率相比，NHW为所有四个疾病groups.CONCLUSIONS：一个显着比例的访问美国急诊科急性胃肠道疾病的延迟与初步临床评估。与其他种族/民族相比，西班牙裔患者等待时间更长，延误频率更高。未来的政策应该针对减少医生评估的延迟和解决这种医疗保健差异。
OBJECTIVES: (i) The aims of this study were to report wait times for visits to US emergency departments (EDs) for acute gastrointestinal illnesses, (ii) to identify whether racial/ethnic disparities exist in wait times, and (iii) to characterize factors associated with delays in physician assessment.METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1997 to 2006. We studied wait times for acute pancreatitis, appendicitis, cholecystitis, and upper gastrointestinal hemorrhage (UGIH). Diagnosis was based on the International Classification of Diseases, Ninth Revision, Clinical Modification. Racial/ethnic categories were defined as non-Hispanic White (NHW), non-Hispanic Black, and Hispanic White (HW). Wait time was stratified by racial/ethnic group and by study year. We evaluated the association between race/ethnicity and frequency of delay relative to triage assignment. Multivariate logistic regression was used to estimate the impact of age, sex, payment status, and geography on wait time.RESULTS: There were an estimated 1.6 million ED visits for acute pancreatitis, 2.2 million visits for appendicitis, 1.2 million visits for cholecystitis, and 3.9 million visits for UGIH in the NHAMCS survey during the study period. Average wait time ranged from 48 min (acute pancreatitis) to 61 min (cholecystitis). We identified a delay in clinical assessment in 24% of cases. In multivariate analysis, race/ethnicity was an independent predictor for increased wait time. HW waited longer and had higher frequency of delays compared with NHW for all four disease groups.CONCLUSIONS: A significant proportion of visits to US EDs for acute gastrointestinal illnesses are associated with a delay in initial clinical assessment. Hispanic patients waited longer and had a higher frequency of delays compared with other racial/ethnic groups. Future policies should be directed at reducing delays in physician assessment and addressing this healthcare disparity.