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: 6017351
• 负责人: ROBERT A. LOWE
• 金额: $ 52.82万
• 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 2002-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6017351
• 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.

1200万次因呼吸系统问题而到急诊室（艾德）就诊 每年都发生在美国。 由于收费高， 艾德护理以及由于担心使用艾德可能会扰乱 传统初级保健提供者提供的护理的连续性， 已经对减少不必要的艾德使用给予了很多关注， 特别是在医疗补助计划的病人和那些接受管理式医疗的病人中， 组织的 这些问题与艾德的使用特别相关 治疗呼吸系统疾病 大多数呼吸科就诊是为了哮喘， 慢性阻塞性肺病和肺炎， 通过早期访问传统的初级保健来预防 设置，并用于上呼吸道感染，咽炎，急性 支气管炎和中耳炎，这些可能会得到更多的处理 在传统的初级保健环境中。 先前的研究集中在使用药物的患者的特征上， 艾德的小问题，并在很大程度上忽略了影响的 初级保健实践结构对艾德利用的影响。因此 以往研究的政策影响有限，因为许多 患者的特征难以改变。 而反观 初级保健实践的结构可能符合 干预 在实施任何改变之前， 适当的EDS使用，将有必要确定什么做法 这些特征导致潜在地可避免的艾德使用。 拟议的队列研究将检查艾德与 参加医疗补助的患者对呼吸问题的利用 管理型医疗机构及其初级保健的特点 提供商 主要结局，呼吸道艾德利用率 疾病和一个子集的这些访问的特点是非紧急的，将 使用管理式医疗提供的索赔数据进行衡量 在个人层面上为所有成员组织。 初级保健提供者站点的特征将通过以下方式进行测量： 现场访问，并辅以管理式护理提供的数据 organization. 本研究将重点关注呼吸道疾病的艾德访视 问题，因为这些访问是频繁的，因为它是似是而非的， 艾德对他们中许多人的照顾可以重新定向到传统的初级教育， 护理设置。 预计分析将确定供应商的特征 反映与艾德使用率相关的访问。 确定这些关联将有助于设计干预措施 减少患者对ED的需求和使用。