Brousseau David C, Hoffmann Raymond G, Nattinger Ann B, Flores Glenn, Zhang Yinghua, Gorelick Marc
Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, CCC 550, 999 N 92nd St, Milwaukee, WI 53226, USA.
Pediatrics. 2007 Jun;119(6):1131-8. doi: 10.1542/peds.2006-3518.
Our objective was to determine whether parent-reported, high-quality primary care was associated with decreased nonurgent pediatric emergency department utilization.
A retrospective analysis of prospectively collected data for a cohort of children from the 2000-2001 and 2001-2002 Medical Expenditure Panel Survey panels was performed. Baseline parent-reported quality of primary care with respect to family-centeredness, timeliness, and realized access (a measure of the child's ability to receive necessary care and referrals) was assessed by using composite scores from the Consumer Assessment of Healthcare Providers and Systems survey. The primary outcomes were the numbers of subsequent nonurgent and urgent emergency department visits per child.
Of 8823 children included, 70.0% rated family-centeredness, 88.2% rated realized access, and 55.6% rated timeliness as high quality. After adjustment for demographic factors and health status, high-quality family-centeredness was associated with a 42% reduction in nonurgent emergency department visits for publicly insured children and a 49% reduction for children < or = 2 years of age. Greater realized access was associated with a 44% reduction in nonurgent emergency department visits for children 3 to 11 years of age and a 56% reduction for children > or = 12 years of age. Greater realized access was also associated with decreased nonurgent emergency department visits for publicly and privately insured children (37% and 35%, respectively). There was no significant association between timeliness and nonurgent emergency department utilization, nor was any quality-of-care domain associated with urgent emergency department utilization.
Parent-reported, high-quality family-centeredness and a high level of realized access to primary care were associated with decreased subsequent nonurgent emergency department visits for children. Parent reports of health care quality in these domains provide important complementary information on health care quality.
我们的目的是确定家长报告的高质量初级保健是否与儿童非紧急情况下急诊就诊次数的减少有关。
对2000 - 2001年和2001 - 2002年医疗支出小组调查中一组儿童的前瞻性收集数据进行回顾性分析。通过使用医疗服务提供者和系统消费者评估调查中的综合评分，评估家长报告的初级保健在以家庭为中心、及时性和实际可及性（衡量儿童获得必要护理和转诊的能力）方面的基线质量。主要结局是每个儿童后续非紧急和紧急急诊就诊的次数。
在纳入的8823名儿童中，70.0%将以家庭为中心评为高质量，88.2%将实际可及性评为高质量，55.6%将及时性评为高质量。在对人口统计学因素和健康状况进行调整后，高质量的以家庭为中心与公共保险儿童非紧急急诊就诊次数减少42%以及2岁及以下儿童减少49%相关。更大的实际可及性与3至11岁儿童非紧急急诊就诊次数减少44%以及12岁及以上儿童减少56%相关。更大的实际可及性还与公共和私人保险儿童非紧急急诊就诊次数减少相关（分别为37%和35%）。及时性与非紧急急诊就诊利用率之间无显著关联，任何护理质量领域与紧急急诊就诊利用率也无关联。
家长报告的高质量以家庭为中心以及初级保健的高实际可及性与儿童后续非紧急急诊就诊次数减少有关。家长在这些领域对医疗质量的报告为医疗质量提供了重要的补充信息。
