地理差异和急性护理利用的设施决定因素以及ACSC的支出
Sadiq Y Patel1, Aaron Baum, Sanjay Basu
1Waymark Care, 2021 Fillmore St, Ste 1059, San Francisco, CA 94115.
The American journal of managed care
|November 15, 2024
概括
地理位置和医疗机构的访问显著影响医疗补助病人的门诊护理敏感条件 (ACSC) 访问. 改善当地卫生基础设施可以减少ACSCs不必要的紧急护理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 医疗保健的获取和利用
背景情况:
- 门诊护理敏感条件 (ACSCs) 通常可以通过及时的初级护理来预防.
- 医疗保健获取方面的差异可能导致脆弱人群中ACSC的急诊室 (ED) 访问和住院病例增加.
- 医疗补助计划的患者代表着面临医疗保健接入挑战的重要人口.
研究的目的:
- 为了比较不同地理位置的医疗补助患者中ACSCs的ED访问和住院率.
- 分析医疗机构决定因素对这些急性护理利用模式的影响.
- 确定导致医疗补助人口中ACSC相关急性护理使用变化的因素.
主要方法:
- 在2019年,对34个州和华盛顿特区的4830万医疗补助病人的回顾性横截面分析.
- 对ACSCs的ED访问和住院的县级变化进行描述性分析.
- 多变量回归检查了卫生设施的近距离和密度与利用率和支出的相关性,并调整了社会经济和健康因素.
主要成果:
- 近40%的医疗补助急症护理访问是针对ACSC的,州和县级的差异很大.
- 距离紧急护理和初级保健短缺指标的增加与更高的ACSC急性护理访问相关.
- 农村卫生诊所密度较高与ACSC相关的急性护理访问较少有关.
- 在分析的州,ACSC急症护理访问占医疗补助总支出的4.2%.
结论:
- 在医疗补助患者中,即使在同一个州内,ACSC的急性护理利用率存在实质性的差异.
- 靠近紧急护理和农村卫生诊所的密度是影响ACSCC急性护理使用的关键因素.
- 当地卫生基础设施在减轻医疗补助人口中ACSCs不必要的急性护理利用方面发挥着关键作用.
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