Colligan Erin M, Pines Jesse M, Colantuoni Elizabeth, Howell Benjamin, Wolff Jennifer L
Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD.
George Washington University School of Medicine and Health Sciences, Washington, DC.
Ann Emerg Med. 2016 Jun;67(6):721-729. doi: 10.1016/j.annemergmed.2016.01.033. Epub 2016 Mar 3.
We examine factors associated with persistent frequent emergency department (ED) use during a 2-year period among Medicare beneficiaries.
We conducted a retrospective, claims-based analysis of fee-for-service Medicare beneficiaries, using the Chronic Condition Data Warehouse's random 20% sample files. We used multinomial logistic regression models to compare frequent ED use (defined as 4 or more ED visits per year) with infrequent use (1 to 3 visits per year), non-ED use, and death in 2010 as a function of sociodemographic, primary care, clinical characteristics, and 2009 ED use.
Approximately 1.1% of Medicare beneficiaries were persistent frequent ED users, defined as experiencing frequent ED use in 2009 and 2010 consecutively. Of the 3.3% of Medicare beneficiaries who were frequent ED users in 2009, 34.3% were frequent ED users, 19.4% were non-ED users, 39.0% were infrequent ED users, and 7.4% died in 2010. Frequent ED use in 2009 was highly associated with frequent ED use in 2010 (relative risk ratio 35.2; 95% confidence interval 34.5 to 35.8). Younger age, Medicaid status, and mental illness were also strong predictors of frequent ED use. The probability of frequent ED use in 2010 was 3.4% for the total sample, but was 19.4% for beneficiaries who were frequent users in 2009 and 49.0% for beneficiaries in the youngest age group who had mental illness, Medicaid, and frequent ED use in 2009.
Efforts to curtail frequent ED use in Medicare should focus on disabled, socially vulnerable beneficiaries.
我们研究了医疗保险受益人在两年期间持续频繁使用急诊科（ED）的相关因素。
我们使用慢性病数据仓库的20%随机抽样文件，对按服务收费的医疗保险受益人进行了回顾性的基于索赔的分析。我们使用多项逻辑回归模型，将频繁使用急诊科（定义为每年4次或更多次急诊科就诊）与不频繁使用（每年1至3次就诊）、不使用急诊科以及2010年的死亡情况进行比较，作为社会人口统计学、初级保健、临床特征以及2009年急诊科使用情况的函数。
约1.1%的医疗保险受益人是持续频繁使用急诊科的用户，定义为在2009年和2010年连续频繁使用急诊科。在2009年频繁使用急诊科的3.3%的医疗保险受益人中，34.3%在2010年仍是频繁使用急诊科的用户，19.4%不再使用急诊科，39.0%是不频繁使用急诊科的用户，7.4%在2010年死亡。2009年频繁使用急诊科与2010年频繁使用急诊科高度相关（相对风险比35.2；95%置信区间34.5至35.8）。年龄较小、医疗补助状态以及精神疾病也是频繁使用急诊科的有力预测因素。2010年频繁使用急诊科的概率在总样本中为3.4%，但在2009年频繁使用急诊科的受益人中为19.4%，在2009年年龄最小且患有精神疾病、享受医疗补助并频繁使用急诊科的受益人中为49.0%。
减少医疗保险受益人频繁使用急诊科的努力应集中在残疾、社会弱势群体上。
