Adekoya Nelson
Coordinating Center for Health Information and Service, National Center for Public Health Informatics, MS-E78, Atlanta, GA 30341, USA.
Public Health Rep. 2007 Jul-Aug;122(4):513-20. doi: 10.1177/003335490712200413.
Emergency departments (EDs) are a critical source of medical care in the U.S. Information is sparse concerning infectious disease visits among Medicaid entitlement enrollees nationwide. The objective of this study was to describe infectious diseases in terms of Medicaid/State Children's Health Insurance Program (SCHIP) as an expected source of payment.
Data for 2003 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of nonfederal, short-stay, and general hospitals in the U.S. Data are collected annually and are weighted to generate national estimates.
Nationally in 2003, an estimated 21.6 million visits were made to hospital EDs for infectious diseases (rate = 76 visits/1,000 people). Medicaid/SCHIP was the expected source of payment for an estimated 6.7 million infectious disease-related visits (rate = 200 visits/1,000 people covered by Medicaid). Children aged < 15 years made 39% of visits nationwide (nationwide rate = 139 visits/1,000 people). Of Medicaid visits, 63% were made by children < 15 years of age (Medicaid enrollees rate = 255 visits/1,000 people). The rate of visits for Medicaid enrollees was comparable for females and males (198 visits vs. 201/1,000 people). The rate of visits for black Medicaid enrollees was 33% higher than for white Medicaid enrollees (255 vs. 192 visits/1,000 people). Upper respiratory tract infection (URTI) is the most frequent infectious condition recorded at ED visits. An estimated 47% of ED visits with an expected pay source of Medicaid relate to URTIs (93 visits/1,000 people), compared with 38% of ED visits in general (29 visits/1,000 people).
Medicaid enrollee-specific ED visit rates for infectious diseases were higher by age group, gender, race, and region, compared with national rates. Because approximately half of visits relate to URTIs for a Medicaid payment group, URTIs should form the basis for development of appropriate control strategies.
急诊科是美国医疗保健的重要来源。关于全国医疗补助计划参保者中传染病就诊情况的信息匮乏。本研究的目的是描述以医疗补助计划/州儿童健康保险计划（SCHIP）作为预期支付来源的传染病情况。
分析了2003年来自全国医院门诊医疗调查（NHAMCS）中传染病就诊的数据。NHAMCS是对美国非联邦、短期住院和综合医院急诊科及门诊就诊情况的全国概率抽样调查。数据每年收集并加权以生成全国估计数。
2003年在全国范围内，估计有2160万人次因传染病前往医院急诊科就诊（发病率=每1000人中有76人次就诊）。医疗补助计划/SCHIP是估计670万次传染病相关就诊的预期支付来源（发病率=每1000名医疗补助计划覆盖人群中有200人次就诊）。15岁以下儿童的就诊人次占全国就诊人次的39%（全国发病率=每1000人中有139人次就诊）。在医疗补助计划就诊中，63%是由15岁以下儿童进行的（医疗补助计划参保者发病率=每1000人中有255人次就诊）。医疗补助计划参保者的就诊率在女性和男性中相当（分别为每1000人中有198人次和201人次就诊）。黑人医疗补助计划参保者的就诊率比白人医疗补助计划参保者高33%（分别为每1000人中有255人次和192人次就诊）。上呼吸道感染（URTI）是急诊科就诊记录中最常见的传染病情况。估计预期支付来源为医疗补助计划的急诊科就诊中，47%与上呼吸道感染有关（每1000人中有93人次就诊），而一般急诊科就诊中这一比例为38%（每1000人中有29人次就诊）。
与全国发病率相比，按年龄组、性别、种族和地区划分，医疗补助计划参保者特定的传染病急诊科就诊率更高。由于约一半的就诊与医疗补助计划支付群体的上呼吸道感染有关，上呼吸道感染应成为制定适当控制策略的基础。
