Department of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.
Acad Pediatr. 2013 May-Jun;13(3):278-85. doi: 10.1016/j.acap.2013.02.006. Epub 2013 Feb 14.
To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs).
A retrospective, cross-sectional analysis was conducted for all visits to Washington, DC's principal pediatric ED between 2003 and 2006. NUVs were defined by a unique algorithm combining resource allocation, ambulatory-sensitive diagnoses, and billing data. Multivariate linear regression analysis was used to determine the association of PCP density and demographic variables on the spatial rate of NUVs.
Over the 4-year period, 35.1% (52,110) of the 148,314 ED visits by Washington, DC, residents were nonurgent. NUVs were most associated with neighborhood median household income <$40,000 and low spatial density of PCPs. For every 1-unit increase in PCP density, the spatial rate of NUVs decreased by 9%. The odds of a visit being nonurgent were significantly higher for African Americans and Hispanics than for whites (odds ratio [OR] 2.4, 95% confidence interval [CI] 2.19-2.64; and OR 2.6, 95% CI 2.36-2.86, respectively), for patients using public insurance versus private (OR 1.46, 95% CI 1.42-1.50), and for patients age <5 years (OR 2.66, 95% CI 2.60-2.72).
Low spatial density of primary care is strongly associated with nonurgent ED utilization. Improving spatial distribution of primary care may decrease ED misuse and improve access to the medical home.
确定到城市儿科急诊就诊的非紧急患儿（NUV）的空间和人口统计学特征。我们假设，NUV 的比例与初级保健提供者（PCP）的空间密度呈反比。
对 2003 年至 2006 年间华盛顿特区主要儿科急诊就诊的所有患者进行了回顾性横断面分析。NUV 通过一种独特的算法来定义，该算法结合了资源分配、门诊敏感诊断和计费数据。使用多元线性回归分析来确定 PCP 密度和人口统计学变量与 NUV 空间率之间的关联。
在 4 年期间，华盛顿特区居民在急诊就诊的 148314 人次中，有 35.1%（52110 人次）为非紧急就诊。NUV 与邻里中位数家庭收入<40000 美元和 PCP 空间密度低关系最密切。PCP 密度每增加 1 个单位，NUV 的空间比例就降低 9%。与白人相比，非裔美国人和西班牙裔的就诊非紧急的可能性明显更高（比值比[OR]为 2.4，95%置信区间[CI]为 2.19-2.64；OR 为 2.6，95%CI 为 2.36-2.86），使用公共保险的患者比使用私人保险的患者（OR 为 1.46，95%CI 为 1.42-1.50），以及年龄<5 岁的患者（OR 为 2.66，95%CI 为 2.60-2.72）。
初级保健的空间密度低与非紧急急诊就诊利用度密切相关。改善初级保健的空间分布可能会减少急诊滥用并改善获得医疗保健的机会。
