医疗保险受益人对非紧急病症的治疗地点：紧急护理中心能发挥作用吗？
Site of Treatment for Non-Urgent Conditions by Medicare Beneficiaries: Is There a Role for Urgent Care Centers?
作者信息
Corwin Gregory S, Parker Devin M, Brown Jeremiah R
机构信息
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH; VA National Center for Patient Safety Field Office, White River Junction, VT.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH.
出版信息
Am J Med. 2016 Sep;129(9):966-73. doi: 10.1016/j.amjmed.2016.03.013. Epub 2016 Apr 12.
BACKGROUND
There is limited information on where and how often Medicare beneficiaries seek care for non-urgent conditions when a physician office visit is not available. Emergency departments are often an alternative site of care, and urgent care centers have now also emerged to fill this need. The purpose of the study was to characterize the site of care for Medicare beneficiaries with non-urgent conditions; the relationship between physician office, urgent care center, and emergency department utilization; and specifically the role of urgent care centers.
METHODS
The study is a retrospective, cross-sectional study of fee-for-service Medicare beneficiaries for fiscal year 2012. The main outcome was rate and geographic variation of urgent care center, emergency department, or physician office utilization.
RESULTS
Care for non-urgent conditions most commonly occurred in physician offices (65.0 per 100 beneficiaries). In contrast, urgent care centers (6.0 per 100 beneficiaries) were a more common site of care than emergency departments (1.0 per 100 beneficiaries). Overall, 83% of non-urgent visits were physician offices, 14% urgent care centers, and 3% emergency departments. There was regional variation in urgent care center, emergency department, and physician office utilization for non-urgent conditions. Areas of higher emergency department utilization correspond to areas of lower urgent care center and physician office utilization, whereas areas of higher urgent care center utilization had lower emergency department utilization.
CONCLUSIONS
Urgent care centers are an important site of care for Medicare beneficiaries for non-urgent conditions. There is regional variation in the use of urgent care centers, emergency departments, and physician offices, with areas of low urgent care center utilization having higher emergency department utilization. The utilization of urgent care centers for treatment for non-urgent conditions may decrease emergency department utilization.
背景
当无法进行医师门诊时，关于医疗保险受益人在何处以及多久寻求一次非紧急情况护理的信息有限。急诊科通常是替代护理场所，而紧急护理中心现在也已出现以满足这一需求。本研究的目的是描述患有非紧急情况的医疗保险受益人的护理场所；医师门诊、紧急护理中心和急诊科使用之间的关系；特别是紧急护理中心的作用。
方法
本研究是对2012财年按服务收费的医疗保险受益人的回顾性横断面研究。主要结果是紧急护理中心、急诊科或医师门诊使用的发生率和地理差异。
结果
非紧急情况的护理最常发生在医师门诊（每100名受益人中有65.0人次）。相比之下，紧急护理中心（每100名受益人中有6.0人次）是比急诊科（每100名受益人中有1.0人次）更常见的护理场所。总体而言，83%的非紧急就诊是在医师门诊，14%在紧急护理中心，3%在急诊科。对于非紧急情况，紧急护理中心、急诊科和医师门诊的使用存在区域差异。急诊科使用较高的地区对应紧急护理中心和医师门诊使用较低的地区，而紧急护理中心使用较高的地区急诊科使用较低。
结论
紧急护理中心是医疗保险受益人非紧急情况护理的重要场所。紧急护理中心、急诊科和医师门诊的使用存在区域差异，紧急护理中心使用低的地区急诊科使用较高。利用紧急护理中心治疗非紧急情况可能会降低急诊科的使用。
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