Meyers A R, Cupples A, Lederman R I, Branch L G, Feltin M, Master R J, Nicastro D, Glover M, Kress D
Boston University School of Public Health, MA 02118.
J Clin Epidemiol. 1988;41(2):163-72. doi: 10.1016/0895-4356(88)90090-x.
A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 +/- 1.26 hospital admissions, 9.9 +/- 22.7 hospital days, 1.5 +/- 2.31 emergency room (ER) visits, and 26.88 +/- 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 +/- 27.1 days per person per year; mean length-of-stay was 9.3 +/- 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (i.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline; more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).
一项针对马萨诸塞州东部205名重度残疾、独立生活的成年人医疗服务利用情况的前瞻性研究表明，每人每年平均住院0.83±1.26次，住院天数为9.9±22.7天，急诊室就诊1.5±2.31次，门诊就诊26.88±44.4次。在住院患者中，平均每人每年住院时间为16.2±27.1天；每次住院的平均住院时长为9.3±14.7天。回归分析表明，以脊髓损伤为主要致残状况的患者住院可能性显著更高。健康自评较低、抑郁程度较高以及急诊室就诊基线次数较多的患者也是如此。健康自评是整个队列（包括未住院者）住院天数的重要预测指标；残疾发病年龄（年龄越大，风险越高）以及基线调查前一个月的卧床残疾天数（残疾天数越多，风险越高）也是如此。在住院患者中，住院总天数与残疾发病年龄（发病较晚，天数较多）和基线住院天数（天数越多，天数越多）均显著相关。住院时长与两个因素显著相关；年龄和残疾发病年龄（在这两种情况下，年龄越大，住院时间越长）。先前的急诊室就诊是后续急诊室就诊的重要预测指标（基线次数越多，后续次数越多）；受访者对参与医疗护理的报告满意度（报告满意度较低，急诊室就诊次数越多）、组织隶属关系以及与朋友或亲属的联系频率也是如此。较高水平的社会互动（即组织隶属关系和更频繁的社交接触）与更多的急诊室就诊相关。先前与医生、执业护士或医师助理的接触是后续门诊就诊的最有力预测指标（基线次数越多，后续次数越多）。后续接触与受访者相对于其他类似残疾者对自身健康的评估（健康状况相对较差，接触次数越多）、年龄（年龄越大，接触次数越多）以及基线急诊室就诊次数（就诊次数越多，接触次数越多）之间也存在显著关系。
