Schlichting Lauren E, Rogers Michelle L, Gjelsvik Annie, Linakis James G, Vivier Patrick M
Hassenfeld Child Health Innovation Institute, Providence, RI.
Department of Epidemiology, Providence, RI.
Acad Emerg Med. 2017 Dec;24(12):1483-1490. doi: 10.1111/acem.13281. Epub 2017 Oct 16.
For many children, the emergency department (ED) serves as the main destination for health care, whether it be for emergent or nonurgent reasons. Through examination of repeat utilization and ED reliance (EDR), in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care.
Nationally representative data from the 2010 to 2014 Medical Expenditure Panel Survey were used to examine the annual ED utilization of children age 0 to 17 years by insurance coverage. Overall utilization, repeat utilization (two or more ED visits), and EDR (percentage of all health care visits that occur in the ED) were examined using multivariate models, accounting for weighting and the complex survey design. High EDR was defined as having > 33% of outpatient visits in a year being ED visits.
A total of 47,926 children were included in the study. Approximately 12% of children visited an ED within a 1-year period. A greater number of children with public insurance (15.2%) visited an ED at least once, compared to privately insured (10.1%) and uninsured (6.4%) children. Controlling for covariates, children with public insurance were more likely to visit the ED (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.40-1.73) than children with private insurance, whereas uninsured children were less likely (aOR = 0.64, 95% CI = 0.51-0.81). Children age 3 and under were significantly more likely to visit the ED than children age 15 to 17, whereas female children and Hispanic and non-Hispanic other race children were significantly less likely to visit the ED than male children and non-Hispanic white children. Among children with ED visits, 21% had two or more visits to the ED in a 1-year period. Children with public insurance were more likely to have two or more visits to the ED (aOR = 1.53, 95% CI = 1.19-1.98) than children with private insurance whereas there was no significant difference in repeat ED utilization for uninsured children. Publicly insured (aOR = 1.70, 95% CI = 1.47-1.97) and uninsured children (aOR = 1.90, 95% CI = 1.49-2.42) were more likely to be reliant on the ED than children with private insurance.
Health insurance coverage was associated with overall ED utilization, repeat ED utilization, and EDR. Demographic characteristics, including sex, age, income, and race/ethnicity were important predictors of ED utilization and reliance.
对许多儿童而言，急诊科是其获得医疗保健的主要场所，无论是出于紧急还是非紧急原因。通过检查重复就诊率和急诊科依赖情况（EDR），以及整体急诊科利用率，我们可以识别出依赖急诊科作为其主要医疗保健来源的亚人群。
使用2010年至2014年医疗支出面板调查的全国代表性数据，按保险覆盖情况检查0至17岁儿童的年度急诊科利用率。使用多变量模型检查整体利用率、重复利用率（两次或更多次急诊科就诊）和EDR（所有医疗保健就诊中在急诊科发生的百分比），同时考虑加权和复杂的调查设计。高EDR被定义为一年内门诊就诊中有超过33%是在急诊科就诊。
共有47926名儿童纳入研究。约12%的儿童在1年内去过急诊科。与有私人保险（10.1%）和无保险（6.4%）的儿童相比，有公共保险的儿童（15.2%）至少去过一次急诊科的人数更多。在控制协变量后，有公共保险的儿童比有私人保险的儿童更有可能去急诊科就诊（调整后的优势比[aOR]=1.55，95%置信区间[CI]=1.40 - 1.73），而无保险的儿童则可能性较小（aOR = 0.64，95% CI = 0.51 - 0.81）。3岁及以下儿童比15至17岁儿童去急诊科就诊的可能性显著更高，而女童以及西班牙裔和非西班牙裔其他种族儿童比男童和非西班牙裔白人儿童去急诊科就诊的可能性显著更低。在去过急诊科的儿童中，21%在1年内去过急诊科两次或更多次。与有私人保险的儿童相比，有公共保险的儿童更有可能去过急诊科两次或更多次（aOR = 1.53，95% CI = 1.19 - 1.98），而无保险儿童的重复急诊科利用率没有显著差异。有公共保险的儿童（aOR = 1.70，95% CI = 1.47 - 1.97）和无保险的儿童（aOR = 1.90，95% CI = 1.49 - 2.42）比有私人保险的儿童更有可能依赖急诊科。
医疗保险覆盖情况与整体急诊科利用率、重复急诊科利用率和EDR相关。人口统计学特征，包括性别、年龄、收入和种族/族裔是急诊科利用率和依赖情况的重要预测因素。
