the Department of Health Services Administration, University of Maryland, College Park.
J Am Board Fam Med. 2013 Nov-Dec;26(6):680-91. doi: 10.3122/jabfm.2013.06.120327.
Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use.
A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use.
One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05).
Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.
因非紧急情况而到急诊部（ED）就诊与医疗服务的连续性中断有关，且成本更高。本研究的目的是确定患者与医护人员的沟通质量和获得常规医疗服务（USC）的机会是否与更多的非紧急 ED 就诊有关。
本研究采用了 2007 年至 2009 年医疗支出面板调查的数据，使用了门槛模型。首先，使用多元逻辑回归模型确定了与非紧急 ED 就诊可能性相关的因素。鉴于已经发生了一次就诊，使用第二个负二项式模型来确定患者与医护人员的沟通或获得医疗服务的机会是否与非紧急 ED 就诊的频率有关。
沟通的一个要素，即医患语言一致，与较少的非紧急 ED 就诊有关（P<.05）。获得医疗服务的几个方面与减少非紧急目的的 ED 就诊有关。其 USC 可在非工作时间提供服务的患者，以及前往 USC 的时间少于 1 小时的患者，较少因非紧急情况而使用 ED（P≤.05）。
通过扩大口译服务和提供非工作时间的医疗服务，可以增强初级保健服务，从而可能减少对非紧急 ED 服务的需求。
