Jaeger Matthew W, Ambadwar Pratibha B, King Andrew J, Onukwube Jennifer I, Robbins James M
Section of Pediatric Emergency Medicine, Department of Pediatrics, University for Arkansas for Medical Sciences, Little Rock, Arkansas.
Center for Applied Research and Evaluation (CARE), Department of Pediatrics, University for Arkansas for Medical Sciences, Little Rock, Arkansas.
J Emerg Med. 2015 Nov;49(5):729-39. doi: 10.1016/j.jemermed.2015.03.001. Epub 2015 May 30.
Ambulatory care sensitive (ACS) conditions are health problems that could be prevented or ameliorated with adequate access to primary care services.
To determine the extent to which ACS conditions account for care received by children in U.S. emergency departments (EDs) and the patient charges for this care.
A retrospective, cross-sectional analysis of the 2010 Nationwide Emergency Department Sample was performed. Patients 0-19 years of age were included and visits for ACS conditions were identified. Main outcome measures were the percentage of visits for ACS conditions, regression models predicting presentation for ACS conditions based on patient demographic characteristics, and ED charges for ACS ED visits.
Of almost 30 million pediatric ED visits in the United States in 2010, 13.2% were for exclusively ACS conditions. Patients with public or no insurance were 1.2 times more likely than privately insured patients to present for an ACS condition. Lower household income (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] 1.33-1.66) and younger patient age (aOR = 2.55; 95% CI 2.41-2.69) were also predictive of an ACS ED visit. The total of charges for ACS visits was almost $3 billion, of which publicly insured patients accounted for $1.5 billion.
Almost one in seven U.S. pediatric ED visits may be preventable by quality primary care. Patients with public insurance and lower income are more likely than other groups to present with ACS conditions. Better access to and use of primary care services could reduce health care costs and relieve ED overcrowding.
门诊可预防疾病（ACS）是指那些通过获得足够的初级保健服务就可以预防或改善的健康问题。
确定ACS疾病在美国急诊科（ED）中儿童就诊情况及此类就诊的患者费用中所占的比例。
对2010年全国急诊科样本进行回顾性横断面分析。纳入0至19岁的患者，并确定ACS疾病的就诊情况。主要结局指标为ACS疾病就诊的百分比、基于患者人口统计学特征预测ACS疾病就诊的回归模型以及ACS急诊就诊的急诊科费用。
2010年美国近3000万次儿科急诊就诊中，13.2%是仅因ACS疾病就诊。有公共保险或无保险的患者因ACS疾病就诊的可能性是有私人保险患者的1.2倍。家庭收入较低（调整后的优势比[aOR]为1.49；95%置信区间[CI]为1.33 - 1.66）和患者年龄较小（aOR = 2.55；95% CI为2.41 - 2.69）也可预测ACS急诊就诊。ACS就诊的总费用近30亿美元，其中有公共保险的患者占15亿美元。
美国儿科急诊就诊中，近七分之一可能通过高质量的初级保健得以预防。有公共保险和低收入的患者比其他群体更易出现ACS疾病。更好地获得和利用初级保健服务可降低医疗成本并缓解急诊科拥挤状况。
