Center for Health Services Research in Primary Care and Geriatrics Research, Veterans Affairs Medical Center, Durham, NC, USA.
Acad Emerg Med. 2010 Oct;17(10):1086-92. doi: 10.1111/j.1553-2712.2010.00870.x.
Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient-level predictors of group membership.
Subjects were adults ≥ 65 years of age treated and released from an academic medical center ED. Latent cluster analysis (LCA) models were estimated to identify groups with similar numbers of primary care (PC), specialist, and outpatient ED visits and hospital days within 12 months preceding the index ED visit.
In this sample (n = 308), five groups with distinct patterns of health service use emerged. Low Users (35%) had fewer visits of all types and fewer hospital days compared to sample means. Low Users were more likely to be female and had fewer chronic health conditions relative to the overall sample (p < 0.05). The ED to Supplement Primary Care Provider (PCP) (23%) group had more PCP visits, but also significantly more ED visits. Specialist Heavy (22%) group members had twice as many specialist visits, but no difference in PCP visits. Members of this class were more likely to be white and male (p < 0.05). High Users (15%) received more care in all categories and had more chronic baseline health conditions (p < 0.05) but no differences in demographic characteristics relative to the whole sample. The ED and Hospital as Substitution Care (6%) group had fewer PC and specialist visits, but more ED visits and hospital days.
In this sample of older ED patients, five groups with distinct patterns of health service use were identified. Further study is needed to determine whether identification of these patient groups can add important information to existing risk-assessment methods.
本研究旨在确定在门诊急诊科（ED）就诊前 12 个月内具有相似医疗服务使用模式的老年患者群体，并确定影响患者群体归属的个体因素。
研究对象为在学术医疗中心 ED 接受治疗并获准出院的年龄≥65 岁的成年人。采用潜在类别分析（LCA）模型确定具有相似初级保健（PC）、专科和门诊 ED 就诊次数以及就诊前 12 个月内住院天数的群体。
在该样本（n=308）中，出现了 5 种具有不同医疗服务使用模式的群体。与样本平均值相比，低使用者（35%）的各类就诊次数和住院天数均较少。与总体样本相比，低使用者更可能为女性，且慢性健康状况较少（p<0.05）。ED 补充初级保健提供者（PCP）（23%）就诊者的 PCP 就诊次数更多，但 ED 就诊次数也明显更多。该类别的专科就诊者（22%）的专科就诊次数是其他就诊者的两倍，但 PCP 就诊次数无差异。该群体成员更可能为白人且为男性（p<0.05）。高使用者（15%）在所有类别中接受了更多的医疗服务，且具有更多的基础慢性健康状况（p<0.05），但与整体样本相比，其人口统计学特征无差异。ED 和医院替代护理（6%）就诊者的 PC 和专科就诊次数较少，但 ED 就诊次数和住院天数更多。
在本老年 ED 患者样本中，确定了 5 种具有不同医疗服务使用模式的群体。进一步的研究需要确定这些患者群体的识别是否可以为现有风险评估方法提供重要信息。
