School of Nursing, Illinois Wesleyan University, Bloomington, Illinois.
OSF Saint Francis, Peoria, Illinois.
Public Health Nurs. 2016 Mar-Apr;33(2):93-8. doi: 10.1111/phn.12238. Epub 2015 Oct 14.
To compare nonurgent emergency department (ED) visits by insured and uninsured adults in a Midwest community.
Records for this secondary data analysis included 84,877 nonurgent visits to a Midwest ED from September 2004 to January 2012. Insured versus uninsured visits were analyzed using t tests for continuous variables and chi-squared tests for categorical variables. Standardized residuals were compared to determine if changes over time were statistically significant.
Variables included demographic characteristics of patients, payment source, patients' access to primary care, acuity rating, time of visit, and the stated reason for the visit.
Of all nonurgent visits, 77.9% were made by insured adults. Insured nonurgent visits were more often made by adults who were female, older, White, and had a primary care provider (PCP). Nonurgent visits on weekdays between the hours of 09:00 and 18:00 were more likely to be uninsured visits. Dental issues were the fourth most common issue for uninsured visits.
Nonurgent ED visits occur when more appropriate options for prompt care are available in the community. Interventions should target both patients and PCPs. While patients should contact their PCP when in need of prompt care, PCPs should refer patients to facilities other than the ED when medically appropriate.
比较中西部社区中参保和未参保成年人的非紧急急诊就诊情况。
本二次数据分析的记录包括 2004 年 9 月至 2012 年 1 月期间中西部急诊的 84877 例非紧急就诊。使用 t 检验比较连续变量和卡方检验比较分类变量，对参保和未参保就诊进行分析。比较标准化残差以确定随时间的变化是否具有统计学意义。
变量包括患者的人口统计学特征、支付来源、患者获得初级保健的情况、疾病严重程度评分、就诊时间以及就诊原因。
所有非紧急就诊中，有 77.9%是由参保成年人就诊。参保非紧急就诊更多见于女性、年龄较大、白人以及有初级保健提供者（PCP）的成年人。在工作日 09:00 至 18:00 之间就诊的非紧急就诊更可能未参保。牙齿问题是非参保就诊的第四大常见原因。
当社区有更合适的即时护理选择时，就会发生非紧急 ED 就诊。干预措施应针对患者和 PCP 同时进行。虽然患者在需要即时护理时应联系其 PCP，但 PCP 在医学上适当的情况下，应将患者转介至其他医疗机构而非 ED。
