在公共保险的儿童中,急性护理的使用对于外围护理敏感的情况
Daniel J Shapiro1, Matt Hall2, Sriram Ramgopal3
1Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA.
概括
超过四分之一的门诊护理敏感条件 (ACSC) 遇到的儿童最初进入急性护理. 周末访问和有资本的保险增加了这种可能性,这表明需要扩大初级保健准入.
科学领域:
- 儿童医疗保健利用情况
- 门诊护理敏感情况 (ACSCs)
- 医疗保健服务研究 医疗服务研究
背景情况:
- 有限的数据存在于急性护理使用在非住院儿童的门诊护理敏感条件 (ACSCs).
- 了解ACSC寻求护理模式对于优化儿科医疗保健提供至关重要.
- 将常见ACSC的护理转移到初级保健机构可以改善健康结果并降低成本.
研究的目的:
- 描述儿童门诊护理敏感条件 (ACSCs) 的初始医疗保健利用模式.
- 确定与在急性护理机构与办公室设置中寻求初级护理相关的因素.
- 为引导ACSC护理向医疗家庭模式的战略提供信息.
主要方法:
- 对于2017-2019年ACSCs的儿科遭遇的回顾性分析.
- 利用IBM沃森市场扫描医疗补助数据库对医疗补助保险儿童的保险索赔进行了分析.
- 采用了概括估计方程,以确定接触特征和初始护理地点 (急性与办公室) 之间的关联.
主要成果:
- 在超过700万的儿科ACSC遭遇中,有27.9%是在急性护理机构 (急诊或紧急护理) 开始的.
- 尿路感染 (52.0%) 和肺炎 (44.6%) 占初次急性护理访问的比例最高.
- 周末接触 (aOR 6.30) 和资本化保险 (aOR 1.55) 与初始急性护理利用率更高的几率显著相关.
结论:
- 对于公共保险儿童而言,大量的门诊护理敏感条件 (ACSC) 遇到的情况始于急性护理环境.
- 扩大初级保健服务的机会,特别是在周末,可能有助于将ACSC护理重定向到医疗机构.
- 调查结果突出了改善初级保健的机会,并减少对常见儿科疾病的急性护理的依赖.
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