Galbraith Alison A, Semura Jeanne, McAninch-Dake Becky, Anderson Nancy, Christakis Dimitri A
University of Washington, Seattle, Washington, USA.
Ambul Pediatr. 2004 Nov-Dec;4(6):509-13. doi: 10.1367/A04-008R.1.
Children covered by Medicaid are at increased risk of emergency department (ED) utilization.Objective.-To examine whether an association exists between ED use and perceived delay in accessing acute care.
Cross-sectional study. We used data from the Consumer Assessment of Health Plans Survey collected by Washington State Medicaid in 2000. We used multivariate logistic regression to determine the odds of any ED use, using a model that included whether the parent reported not always receiving illness care for the child as soon as wanted (perceived delay), age, gender, race/ethnicity, health status, presence of a special health care need, primary language, needing an interpreter, parental education, and having a regular provider.
Parents of a random sample of children from 9 Medicaid managed care plans were surveyed if their children were <15 years old and enrolled at least 6 months.
Any ED use in the past 6 months.
The response rate was 56.3%, yielding 5142 subjects. Of children with illnesses in the previous 6 months, 69.1% of parents reported that their child always received care as soon as they wanted; 19.9%, 8.2%, and 2.8% reported usually, sometimes, and never, respectively. Not always (vs always) receiving illness care as soon as wanted was significantly associated with increased odds of any ED use (adjusted odds ratio: 1.79; 95% confidence interval: 1.35- 2.36).
Children with managed care Medicaid are more likely to use the ED if parents perceive any delay in receiving illness care.
参加医疗补助计划的儿童急诊就诊风险增加。
研究急诊就诊与感知到的获得急性护理延迟之间是否存在关联。
横断面研究。我们使用了华盛顿州医疗补助计划在2000年收集的消费者健康计划调查数据。我们使用多变量逻辑回归来确定任何急诊就诊的几率，模型包括父母是否报告孩子并非总能尽快获得所需的疾病护理（感知延迟）、年龄、性别、种族/族裔、健康状况、是否有特殊医疗需求、主要语言、是否需要口译员、父母教育程度以及是否有固定的医疗服务提供者。
对来自9个医疗补助管理式医疗计划的随机抽取的儿童样本的父母进行调查，条件是他们的孩子年龄小于15岁且参保至少6个月。
过去6个月内的任何急诊就诊情况。
回复率为56.3%，共获得5142名研究对象。在前6个月内生病的儿童中，69.1%的父母报告他们的孩子总能尽快获得所需护理；分别有19.9%、 8.2%和2.8%的父母报告孩子通常、有时和从未能尽快获得所需护理。并非总能尽快获得所需疾病护理（与总能尽快获得相比）与任何急诊就诊几率增加显著相关（调整后的优势比：1.79；95%置信区间：1.35 - 2.36）。
如果父母感觉到在获得疾病护理方面存在任何延迟，参加管理式医疗补助计划的儿童更有可能使用急诊服务。
