Rosenblatt R A, Wright G E, Baldwin L M, Chan L, Clitherow P, Chen F M, Hart L G
Department of Family Medicine, University of Washington School of Medicine, Seattle 98195-4696, USA.
Am J Public Health. 2000 Jan;90(1):97-102. doi: 10.2105/ajph.90.1.97.
This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994.
A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
本研究旨在确定老年人急诊科就诊率，并调查患者有初级保健医生时就诊率是否会降低。
利用医疗保健财务管理局的国家索赔历史档案，研究1994年华盛顿州65岁以上医疗保险患者的急诊科就诊情况。
在研究年度，共有18.1%的患者有1次或更多次急诊科就诊；就诊率随年龄和疾病严重程度增加。对于各类疾病严重程度，有初级保健医生的患者使用急诊科的可能性要小得多。在控制了病例组合、医疗补助资格和农村/城市居住情况后，有全科初级保健医生的患者进行任何急诊科就诊的比值比为0.47，有专科初级保健医生的患者为0.58。
老年人急诊科就诊率很高，且大多数就诊是因严重医疗问题。与医生建立持续关系——无论专科如何——可能会减少急诊科就诊。
