Gordon J A, Chudnofsky C R, Hayward R A
Department of Emergency Medicine, University of Michigan, USA.
J Urban Health. 2001 Mar;78(1):104-11. doi: 10.1093/jurban/78.1.104.
As a safety net provider for many disadvantaged Americans, the emergency department (ED) may be an efficient site not only for providing acute medical care, but also for addressing serious social needs.
To characterize the social needs of ED patients, and to evaluate whether the most disadvantaged patients have connections with the health and welfare system outside the ED.
Cross-sectional survey conducted over 24 hours in the fall of 1997.
Three EDs: an urban public teaching hospital, a suburban university hospital, and a semirural community hospital.
Consecutive patients presenting for care, including those transported by ambulance. The survey response rate was 91% (N = 300; urban = 115, suburban = 102, rural = 83).
Index of socioeconomic deprivation described by the US Census Bureau (based on food, housing, and utilities).
Of all ED patients, 31% reported one or more serious social deprivations. For example, 13% of urban patients reported not having enough food to eat, and 9% of rural patients reported disconnection of their gas or electricity (US population averages both less than 3%). While 40% of all patients had no consistent health care outside the ED (< or = 1 visit/year), those with higher levels of social deprivation had the least contact with the health care system outside the ED (P < .01). Although those with higher levels of deprivation were more likely to receive public assistance, still almost one-quarter of patients with high-level social deprivation were not receiving public aid.
Many ED patients suffer from fundamental social deprivations that threaten basic health. The most disadvantaged of these patients frequently lack contact with other medical care sites or public assistance networks. Community efforts to address serious social deprivation should include partnerships with the local ED.
作为许多弱势美国人群的安全网提供者，急诊科（ED）可能不仅是提供急性医疗护理的有效场所，也是满足严重社会需求的有效场所。
描述急诊科患者的社会需求，并评估最弱势患者在急诊科之外与健康和福利系统是否有联系。
1997年秋季进行的为期24小时的横断面调查。
三家急诊科：一家城市公立教学医院、一家郊区大学医院和一家半农村社区医院。
连续前来就诊的患者，包括那些由救护车送来的患者。调查回复率为91%（N = 300；城市 = 115，郊区 = 102，农村 = 83）。
美国人口普查局描述的社会经济剥夺指数（基于食品、住房和公用事业）。
在所有急诊科患者中，31%报告有一项或多项严重社会剥夺情况。例如，13%的城市患者报告没有足够的食物吃，9%的农村患者报告燃气或电力供应中断（美国总体人口比例均低于3%）。虽然40%的患者在急诊科之外没有稳定的医疗保健（每年就诊次数≤1次），但社会剥夺程度较高的患者与急诊科之外的医疗保健系统联系最少（P < 0.01）。尽管剥夺程度较高的患者更有可能获得公共援助，但仍有近四分之一社会剥夺程度高的患者没有得到公共援助。
许多急诊科患者遭受着威胁基本健康的根本性社会剥夺。这些患者中最弱势的群体经常与其他医疗场所或公共援助网络缺乏联系。解决严重社会剥夺问题的社区努力应包括与当地急诊科建立伙伴关系。
