DOES PRIMARY CARE ACCESS DECREASE RESPIRATORY ED VISITS?

因呼吸道问题就诊的急诊科(ED)达1200万人次 在美国每年都会发生。因为高额的费用 急症室护理，因为担心使用急症室可能会扰乱 传统初级保健提供者提供的连续性护理， 已经对减少不必要的ED使用给予了很大关注， 特别是在医疗补助患者和管理型医疗保健中 组织。这些关注尤其与教育署的使用有关 呼吸疾病的治疗。大多数呼吸道就诊都是为了哮喘， 慢性阻塞性肺病和肺炎，可能有 因较早去传统的初级保健中心就诊而被阻止 适用于上呼吸道感染、咽炎、急性 支气管炎和中耳炎，这可能会得到更多的处理 适当地在传统的初级保健环境中。 先前的研究主要集中在患者的特征上 对于小问题，教育署在很大程度上忽略了 关于急诊室利用的初级保健做法的结构。因此， 之前的研究对政策的影响有限，因为许多 患者的特征很难修改。相比之下， 初级保健实践的结构潜在地服从于 干预。在实施任何更改以实现更多目标之前 适当地使用EDS，将有必要确定什么做法 这些特点导致了可能避免的ED的使用。 拟议的队列研究将检查ED与 参加医疗补助的患者对呼吸问题的利用 管理型保健组织及其初级保健的特点 供应商。主要结果，呼吸系统的ED使用率 疾病和那些被描述为非紧急的访问的子集，将 使用由托管医疗机构提供的索赔数据进行测量 在个人层面上为其所有成员组织。 初级保健提供者地点的特征将通过以下方式进行衡量 现场访问，辅以管理型医疗保健提供的数据 组织。这项研究将重点放在呼吸系统的急诊科就诊 问题，因为这些访问是频繁的，因为这是合理的 教育署照顾他们中的许多人可以重新定向到传统的小学 护理设置。 预计分析将确定提供商的特征 反映与ED使用率相关联的访问。 确定这些关联将允许设计干预措施 减少患者对急救药物的需求和使用。

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.