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2012-2017年医疗复杂性的儿童在紧急部门的选择中的农村和城市差异

Seneca D Freyleue1, Mary Arakelyan2, Andrew P Schaefer1

  • 1The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover.

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患有医疗复杂性 (CMC) 的儿童因居住地而异地绕过急诊室. 农村CMC与城市CMC相比,绕过他们最近的ED的可能性较小.

关键词:
医疗服务研究医疗复杂性农村地区在城市

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科学领域:

  • 儿童紧急医疗
  • 医疗服务研究
  • 农村的健康差异

背景情况:

  • 患有医疗复杂性 (CMC) 的儿童通常需要专门的护理,影响他们的急诊室 (ED) 选择.
  • 了解CMC的ED使用模式,特别是农村地区的差异,对于医疗保健规划至关重要.
  • 之前的研究还没有广泛探讨农村和城市环境中CMC的ED绕道行为.

研究的目的:

  • 描述农村和城市的ED护理和CMC绕道模式的差异.
  • 检查ED绕道和访问结果之间的关联,包括转移,入院和死亡率.
  • 确定影响CMCED绕道决策的因素.

主要方法:

  • 分析了科罗拉多州,马萨诸塞州和新罕布什尔州2012年至2017年的全部索赔数据.
  • 绕道的定义是距离最近的ED距离的驾驶时间差 ≥5分钟.
  • 使用后勤回归模型识别与绕道相关的因素及其对结果的影响.

主要成果:

  • 总共有82,747个CMC进行了284,374次ED访问.
  • 农村的CMC与城市的CMC相比,绕过最近的ED (26.9%) 的可能性较小.
  • 脱发管绕道与住院率的增加有关 (OR=2. 19),但与医院间转移或死亡率无关. 慢性疾病增加了绕道风险, 而医疗补助减少了它们.

结论:

  • 在ED寻求护理行为和CMC绕道模式方面存在显著的农村和城市差异.
  • 对于CMC来说,ED绕道与更高的入院率有关,突出显示了潜在的护理协调挑战.
  • 根据地理和社会经济因素,研究结果可以为改善ED接入和治疗CMC提供有针对性的干预措施.