Primary Care Office Visits For Acute Care Dropped Sharply In 2002-15, While ED Visits Increased Modestly
Primary Care Office Visits For Acute Care Dropped Sharply In 2002-15, While ED Visits Increased Modestly
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DOI：
10.1377/hlthaff.2018.05184
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发表时间：
2019-02-01
期刊：
影响因子：
9.7
通讯作者：
Pitts, Stephen R.
中科院分区：
文献类型：
--
作者：
Chou, Shih-Chuan;Venkatesh, Arjun K.;Pitts, Stephen R.
作为急病护理主要提供者的初级保健做法的传统模式正在迅速改变。在过去的二十年里，急诊科就诊的增长促使人们努力减少“不适当的”急诊科的使用。我们调查了2002-15年间具有全国代表性的办事处和教育部门访问的样本。我们发现急诊使用率增加了12%(从每1000人385次就诊增加到430次就诊)，而初级保健诊所的急诊就诊率下降了近三分之一(从每1000人938次就诊到637次就诊)，这一点相形见绌。初级保健急诊的减少也出现在两个弱势群体中：医疗补助受益人和参加医疗保险或私人保险的65岁以上的成年人。随着急救服务的提供逐渐脱离初级保健做法，越来越需要在患者寻求急诊护理的越来越多样化的场所之间进行整合和协调。
The traditional model of primary care practices as the main provider of care for acute illnesses is rapidly changing. Over the past two decades the growth in emergency department (ED) visits has spurred efforts to reduce "inappropriate" ED use. We examined a nationally representative sample of office and ED visits in the period 2002-15. We found a 12 percent increase in ED use (from 385 to 430 visits per 1,000 population), which was dwarfed by a decrease of nearly one-third in the rate of acute care visits to primary care practices (from 938 to 637 visits per 1,000 population). The decrease in primary care acute visits was also present among two vulnerable populations: Medicaid beneficiaries and adults ages sixty-five and older, either in Medicare or privately insured. As acute care delivery shifts away from primary care practices, there is a growing need for integration and coordination across an increasingly diverse spectrum of venues where patients seek care for acute illnesses.