解释慢性阻塞性肺疾病患者获得医疗服务的因素与医疗资源利用之间的联系。
Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD.
作者信息
Kim Minchul, Ren Jinma, Tillis William, Asche Carl V, Kim Inkyu K, Kirkness Carmen S
机构信息
Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA.
OSF St Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, USA; Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA.
出版信息
Int J Chron Obstruct Pulmon Dis. 2016 Feb 22;11:357-67. doi: 10.2147/COPD.S95717. eCollection 2016.
BACKGROUND
Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED) visits and primary care physician (PCP) office visits among adults with COPD utilizing a nationally representative survey data.
METHODS
We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011-2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers.
RESULTS
Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp) (P=0.028). In contrast, an additional hospital per 100,000 persons increases the likelihood of hospital/ED visit by 0.8 pp (P=0.008). However, safety net facilities were not related to hospital utilizations. PCP office visits were not related to access-to-care factors.
CONCLUSION
Pulmonary care specialist availability was a key factor in reducing hospital utilization among adults with COPD. The findings of our study implied that an increase in the availability of pulmonary care specialists may reduce hospital utilizations in counties with little or no access to pulmonary care specialists and that since availability of hospitals increases hospital utilization, directing patients with COPD to pulmonary care specialists may decrease hospital utilizations.
背景
获得医疗保健的机会有限可能是获得优质护理的障碍。很少有研究调查获得护理因素与慢性阻塞性肺疾病（COPD）住院之间的关联。本研究的目的是利用具有全国代表性的调查数据，估计获得护理因素与医疗保健利用之间的关联，包括COPD成人患者的住院/急诊就诊和初级保健医生（PCP）门诊就诊情况。
方法
我们基于双变量概率模型进行了汇总横断面分析，使用了2011 - 2012年行为危险因素监测系统与2014年地区卫生资源文件的数据，这些数据涉及COPD成人患者。二分结果是住院/急诊就诊和PCP门诊就诊。关键协变量是县级获得护理因素，包括按人口加权的肺部护理专家、PCP、医院、农村卫生中心和联邦合格健康中心的数量。
结果
在总共9332例观察对象中，住院/急诊就诊和PCP门诊就诊的比例分别为16.2%和44.2%。结果表明，获得护理因素与住院/急诊就诊密切相关。每10万人增加一名肺部护理专家可使住院/急诊就诊的可能性降低0.4个百分点（P = 0.028）。相比之下，每10万人增加一家医院会使住院/急诊就诊的可能性增加0.8个百分点（P = 0.008）。然而，安全网设施与住院利用无关。PCP门诊就诊与获得护理因素无关。
结论
肺部护理专家的可获得性是降低COPD成人患者住院率的关键因素。我们的研究结果表明，在很少或没有肺部护理专家的县，增加肺部护理专家的可获得性可能会降低住院率，并且由于医院数量的增加会提高住院率，将COPD患者转诊至肺部护理专家可能会降低住院率。
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