DeLia Derek, Lloyd Kristen, Feldman Cecile A, Cantor Joel C
Center for State Health Policy, Rutgers University, New Brunswick, NJ, USA.
School of Dental Medicine, Rutgers University, Newark, NJ, USA.
J Public Health Dent. 2016 Winter;76(1):1-8. doi: 10.1111/jphd.12103. Epub 2015 May 20.
To describe emergency department (ED) utilization for oral conditions (OCs) focusing on total volume, costs, repeat utilization, small area predictors, and implications for dental and medical care coordination.
Administrative and demographic data for New Jersey were used to identify users of the ED for OCs and a group of "high users," defined as individuals with four or more ED visits for OCs during 2008-2010. Cost-to-charge ratios were used to estimate costs, and linear regression models applied to zip codes were used to determine strongest predictors of small area variation in ED use for OCs.
ED visits for OC generated $25.5 million in costs during 2008-2010. High users represented 4.2 percent of all users and 21.3 percent of ED visits for OCs. Almost all high users had a diagnosis of "dental disorder not otherwise specified," and tobacco use disorder was the most common comorbid medical condition. Young adults (ages 19-34), non-Hispanic blacks, and the medically uninsured were over-represented among high users. High users routinely spread their use across multiple hospitals (e.g., 40 percent of them visited three or more hospitals). Local dentist supply and ED use for other conditions were significant predictors of zip code-level ED use for OCs.
Coordination of medical and dental treatment might improve health and reduce costs if targeted to high user populations. Health-care delivery reforms, such as accountable care organizations, could provide vehicles for achieving this coordination. Important challenges include fragmentation of ED visits across hospitals, adequacy of dentist supply, and broader reliance on the ED for health problems.
描述口腔疾病（OCs）在急诊科（ED）的利用情况，重点关注总量、成本、重复利用情况、小区域预测因素以及对牙科和医疗护理协调的影响。
利用新泽西州的行政和人口数据来确定因OCs前往ED的使用者以及一组“高使用者”，“高使用者”定义为在2008 - 2010年期间因OCs前往ED就诊4次或更多次的个体。使用成本收费比来估算成本，并应用邮政编码的线性回归模型来确定小区域OCs在ED使用差异的最强预测因素。
2008 - 2010年期间，因OCs前往ED就诊产生了2550万美元的成本。高使用者占所有使用者的4.2%，占OCs在ED就诊人次的21.3%。几乎所有高使用者都被诊断为“未另作规定的牙科疾病”，烟草使用障碍是最常见的合并内科疾病。高使用者中，19 - 34岁的年轻人、非西班牙裔黑人以及未参保者占比过高。高使用者通常在多家医院就诊（例如，其中40%的人就诊于三家或更多医院）。当地牙医供应情况以及其他疾病在ED的使用情况是邮政编码区域层面OCs在ED使用情况的重要预测因素。
如果针对高使用者群体，医疗和牙科治疗的协调可能会改善健康状况并降低成本。诸如 accountable care organizations（可问责医疗组织）等医疗保健提供改革可以为实现这种协调提供途径。重要挑战包括医院间ED就诊的分散化、牙医供应的充足性以及对ED处理健康问题的更广泛依赖。
