Larkin Gregory Luke, Claassen Cynthia A, Pelletier Andrea J, Camargo Carlos A
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8579, USA.
Prehosp Disaster Med. 2006 Mar-Apr;21(2):82-90. doi: 10.1017/s1049023x0000340x.
Understanding ambulance utilization patterns is essential to assessing prehospital system capacity and preparedness at the national level.
To describe the characteristics of patients transported to U.S. emergency departments (EDs) by ambulance and to determine predictors of ambulance utilization.
Data were obtained from the National Hospital Ambulatory Medical Care Survey using mode of arrival, demographic and visit information, ICD-9-CM E and V-codes, and classified reasons for the visit.
The rates for ED visits of persons conveyed by ambulence were stable between 1997 and 2003, consisting of approximately one in every seven ED visits (14%). In 2003, there were 16.2 million ED visits for which an ambulance was used in the U.S. However, for patients with mental health visits, nearly one in three ED presentations (31%) arrived by ambulance. Significantly higher rates of ambulance use were associated with: (1) mental health visits; (2) older age; (3) African-Americans; (4) Medicare or self-pay insurance status; (5) urban ED location; (6) U.S. regions outside of the South; (7) presentation between 12 midnight to 0800 hours; (8) injury-related visits; (9) urgent visit status; and/or (10) those resulting in hospital admission. Among mental health patients, older age, self-pay insurance status, urban ED location, regions outside the southern US, and urgent visit classification predicted ambulance use. Ambulance usage within the mental health group was highest for suicide and lowest for mood and anxiety disorder-related visits.
Reliance on ambulance services varies by age, insurance status, geographic factors, time of day, urgency of visit, subsequent admission status, and type of mental health disorder. Even after controlling for many confounding factors, mental health problems remain an important predictor of ambulance use.
了解救护车使用模式对于评估国家层面的院前系统能力和准备情况至关重要。
描述通过救护车转运至美国急诊科（ED）的患者特征，并确定救护车使用的预测因素。
数据来自国家医院门诊医疗调查，使用到达方式、人口统计学和就诊信息、ICD-9-CM E和V编码以及就诊分类原因。
1997年至2003年间，由救护车运送的人员到急诊科就诊的比例稳定，约占每七次急诊科就诊中的一次（14%）。2003年，美国有1620万次急诊科就诊使用了救护车。然而，对于心理健康就诊患者，近三分之一的急诊科就诊（31%）是乘坐救护车到达的。救护车使用比例显著较高与以下因素相关：（1）心理健康就诊；（2）年龄较大；（3）非裔美国人；（4）医疗保险或自费保险状况；（5）城市急诊科位置；（6）美国南部以外的地区；（7）午夜12点至早上8点就诊；（8）与损伤相关的就诊；（9）紧急就诊状态；和/或（10）导致住院的就诊。在心理健康患者中，年龄较大、自费保险状况、城市急诊科位置、美国南部以外的地区以及紧急就诊分类可预测救护车使用情况。心理健康组中，自杀患者的救护车使用率最高，情绪和焦虑障碍相关就诊患者的使用率最低。
对救护车服务的依赖因年龄、保险状况、地理因素、就诊时间、就诊紧急程度、后续住院状况以及心理健康障碍类型而异。即使在控制了许多混杂因素之后，心理健康问题仍然是救护车使用的重要预测因素。
