Pittard William B
Department of Pediatrics, Division of Pediatric Epidemiology and Health Systems Research, Medical University of South Carolina, Charleston, SC 29425, USA.
South Med J. 2011 Aug;104(8):604-8. doi: 10.1097/SMJ.0b013e31822426c0.
This analysis tests the hypothesis that children enrolled in Medicaid with the recommended early and periodic screening, diagnosis and treatment (EPSDT) visits in the first 24 months utilize fewer emergency department (ED) services birth to 6 years old than children with fewer visits.
Data represent all health encounters for a 3-year birth cohort of South Carolina children continuously enrolled in Medicaid from birth to 6 years old (n = 18,512). The association between receiving the American Academy of Pediatrics recommended EPSDT visits and other health service utilization is examined.
Children with the recommended EPSDT visits had a greater adjusted rate of sick-child visits with a primary care provider (rate ratio, 1.62; 95% CI 1.50- 1.76) and a lower adjusted rate of ED visits for ambulatory care-sensitive conditions (rate ratio, 0.88; 95% CI, 0.81-0.95).
Recommended EPSDT use in infancy may be associated with a shift in health care from the ED to the office setting by children enrolled in Medicaid in the first six years of life.
本分析检验了这样一个假设，即在出生后头24个月内按照推荐进行早期和定期筛查、诊断及治疗（EPSDT）访视的医疗补助计划参保儿童，在出生至6岁期间使用的急诊科（ED）服务比访视次数较少的儿童少。
数据代表了南卡罗来纳州一个为期3年的出生队列中从出生到6岁持续参保医疗补助计划的儿童的所有健康诊疗情况（n = 18,512）。研究了接受美国儿科学会推荐的EPSDT访视与其他医疗服务利用之间的关联。
接受推荐的EPSDT访视的儿童，与初级保健提供者进行病儿访视的调整率更高（率比，1.62；95%可信区间1.50 - 1.76），因非卧床护理敏感病症进行急诊就诊的调整率更低（率比，0.88；95%可信区间，0.81 - 0.95）。
婴儿期推荐使用EPSDT可能与医疗补助计划参保儿童在生命的头六年中医疗保健从急诊科向门诊转移有关。
