DOES PRIMARY CARE ACCESS DECREASE RESPIRATORY ED VISITS?

初级保健服务是否会减少呼吸科急诊就诊次数？

• 批准号: 2638567
• 负责人: ROBERT A. LOWE
• 金额: $ 48.73万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-06-01 至 2000-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2638567
• 关键词: Medicare /Medicaid; behavioral /social science research tag; clinical research; emergency health services; health care service availability; health care service evaluation; hospital utilization; human subject; respiratory disorder

Twelve million emergency department (ED) visits for respiratory problems occur annually in the United States. Because of the high charges for ED care and because of concerns that use of the ED may disrupt the continuity of care available from traditional primary care providers, much attention has been given to decreasing unnecessary ED use, especially among Medicaid patients and among those in managed care organizations. These concerns are especially relevant to use of the ED for respiratory problems. Most respiratory visits are for asthma, chronic obstructive pulmonary disease, and pneumonia, which might have been prevented by an earlier visit to a traditional primary care setting, and for upper respiratory tract infections, pharyngitis, acute bronchitis, and otitis media, which might have been handled more appropriately in a traditional primary care setting. Prior research has focused on characteristics of patients who use the ED for minor problems and has largely ignored the effect of the structure of primary care practices on ED utilization. Therefore, the policy impact of previous research has been limited, as many characteristics of patients are difficult to modify. In contrast, the structure of primary care practices is potentially amenable to intervention. Before implementing any change to achieve more appropriate EDS use, it will be necessary to determine what practice characteristics lead to potentially avoidable ED use. The proposed cohort study will examine the relationship between ED utilization for respiratory problems by patients enrolled in a Medicaid managed care organization and characteristics of their primary care providers. The principal outcomes, ED utilization rates for respiratory disease and a subset of those visits characterized as nonurgent, will be measured using claims data, to be provided by the managed care organization for all of its members at the individual level. Characteristics of primary care provider sites will be measured through site visits, supplemented by data available form the managed care organization. The study will focus on ED visits for respiratory problems, because these visits are frequent and because it is plausible that ED care for many of them can be redirected to traditional primary care settings. It is expected that the analysis will identify provider characteristics reflective of access that are associated with the rate of ED use. Identifying these associations will allow the design of interventions to decrease patients need for and use of EDs.

一千二百万次因呼吸系统问题而到急诊科 (ED) 就诊 每年都会在美国发生。 由于收费较高 急诊室护理以及由于担心使用急诊室可能会扰乱 传统初级保健提供者提供的连续性护理， 人们非常重视减少不必要的急诊室使用， 尤其是在医疗补助患者和接受管理式护理的患者中 组织。 这些问题与 ED 的使用尤其相关 对于呼吸系统问题。 大多数呼吸道就诊是因为哮喘， 慢性阻塞性肺疾病和肺炎，可能会导致 因提前就诊传统初级保健而被阻止 用于治疗上呼吸道感染、咽炎、急性 支气管炎和中耳炎，这些本来可以得到更多处理 适当地在传统的初级保健环境中。 先前的研究重点关注使用该药物的患者的特征 ED 只针对小问题，并且在很大程度上忽略了 急诊室利用的初级保健实践结构。因此， 先前研究的政策影响有限，因为许多 患者的特征很难改变。 相比之下， 初级保健实践的结构可能适合 干涉。 在实施任何改变以实现更多目标之前 适当的 EDS 使用，有必要确定什么做法 这些特性导致了潜在的可避免的 ED 使用。 拟议的队列研究将检查 ED 之间的关系 参加医疗补助计划的患者用于治疗呼吸系统疾病 管理式医疗组织及其初级保健的特点 提供商。 主要结果：呼吸科急诊室利用率 疾病和那些非紧急就诊的子集，将 使用管理式医疗提供的理赔数据进行衡量 其所有成员在个人层面上的组织。 初级保健提供者地点的特征将通过以下方式衡量 实地考察，并辅以管理式医疗提供的数据 组织。 该研究将重点关注呼吸系统疾病的急诊室就诊 问题，因为这些访问很频繁，而且是合理的 对他们中的许多人来说，急诊室护理可以转至传统的初级护理 护理设置。 预计该分析将确定提供商的特征 反映与 ED 使用率相关的访问情况。 识别这些关联将有助于设计干预措施 减少患者对急诊室的需求和使用。