Gadomski A, Jenkins P
Bassett Research Institute, Cooperstown, NY 13326, USA.
Health Serv Res. 2001 Apr;36(1 Pt 1):129-42.
To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously been described (Braveman, Schaaf, Egerter, et al. 1994).
DATA SOURCES/STUDY SETTING: State of Maryland Medicaid claims data for children < or = 18 years of age from 1989 to 1993 and hospital discharge data for children < or = 19 years of age from 1989 to 1994 were analyzed.
Administrative data analysis pre- and post-implementation of a Medicaid managed care program called Maryland Access to Care.
DATA COLLECTION/EXTRACTION METHODS: Medicaid claims and hospital discharge ICD-9-CM codes were used to define hospitalization for ruptured and nonruptured appendicitis. Linear regression was used to model trends. Logistic regression was used to model the probability of ruptured appendicitis.
Among the 374 Medicaid inpatient claims for appendicitis, 37 percent were for ruptured appendicitis. Among the 5,141 hospital discharges for appendicitis, 30 percent were for ruptured appendicitis. Using Medicaid claims data, the probability of ruptured appendicitis was inversely related to age (OR = 0.86, 95% CI 0.81-0.91), white race (OR = 0.35, 95% CI 0.17-0.71) and preventive care visits (OR = 0.19, 95% CI 0.05-0.77). Using hospital discharge data, age (OR = 0.91, 95% CI 0.90-0.93) and female gender (OR = 0.87, 95% CI 0.77-0.99) were significant covariates. Insurance-related covariates were not significant in multivariate models addressing the probability of ruptured appendicitis.
During a period of rapid managed care growth, insurance type was not associated with an increased risk of ruptured appendicitis among children in this geographic area. Age, female gender, and the number of preventive care visits are inversely related to the risk of ruptured appendix among children. The protective effect of preventive care visits suggests that a primary care relationship facilitates access to care, thus reducing delay in the management of appendicitis.
利用行政数据库确定儿童阑尾炎破裂的相关因素。此前已有研究描述了加利福尼亚州成年人阑尾炎破裂风险中与保险相关的差异（Braveman、Schaaf、Egerter等人，1994年）。
数据来源/研究背景：分析了1989年至1993年马里兰州医疗补助计划中18岁及以下儿童的索赔数据，以及1989年至1994年19岁及以下儿童的医院出院数据。
对名为“马里兰州医疗服务准入”的医疗补助管理式医疗计划实施前后的行政数据分析。
数据收集/提取方法：使用医疗补助索赔数据和医院出院的国际疾病分类第九版临床修订本（ICD-9-CM）编码来定义阑尾炎破裂和未破裂的住院情况。采用线性回归对趋势进行建模。采用逻辑回归对阑尾炎破裂的概率进行建模。
在374份阑尾炎医疗补助住院索赔中，37%是阑尾炎破裂的索赔。在5141例阑尾炎医院出院病例中，30%是阑尾炎破裂病例。利用医疗补助索赔数据，阑尾炎破裂的概率与年龄呈负相关（比值比[OR]=0.86，95%可信区间[CI]0.81-0.91）、白人种族（OR=0.35，95%CI0.17-0.71）和预防性保健就诊次数（OR=0.19，95%CI0.05-0.77）。利用医院出院数据，年龄（OR=0.91，95%CI0.90-0.93）和女性性别（OR=0.87，95%CI0.77-0.99）是显著的协变量。在针对阑尾炎破裂概率的多变量模型中，与保险相关的协变量不显著。
在管理式医疗快速发展的时期，该地理区域内儿童阑尾炎破裂风险增加与保险类型无关。年龄、女性性别和预防性保健就诊次数与儿童阑尾炎破裂风险呈负相关。预防性保健就诊的保护作用表明，初级保健关系有助于获得医疗服务，从而减少阑尾炎治疗的延迟。
