患有 ED 的刑事司法接触者与其他 ED 用户相比如何？加利福尼亚州 ED 就诊的回顾性分析。
How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California.
机构信息
Public Policy Institute of California, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
出版信息
BMJ Open. 2018 Jun 21;8(6):e020897. doi: 10.1136/bmjopen-2017-020897.
OBJECTIVE
To assess the patterns of emergency department (ED) utilisation among those with and without criminal justice contact in California in 2014, comparing variation in ED use, visit frequency, diagnoses and insurance coverage.
DESIGN
Retrospective, cross-sectional study.
SETTING
Analyses included ED visits to all licensed hospitals in California using statewide data on all ED encounters in 2014.
PARTICIPANTS
Study participants included 3 757 870 non-elderly adult ED patients who made at least one ED visit in 2014.
PRIMARY AND SECONDARY OUTCOME MEASURES
We assessed the patterns and characteristics of ED visits among those with criminal justice contact-patients who were either admitted to or discharged from the ED by a correctional institution-with patients who did not have criminal justice contact recorded during an ED visit.
RESULTS
ED patients with criminal justice contact had higher proportions of frequent ED users (27.2% vs 9.4%), were at higher risk of an ED visit resulting in hospitalisation (26.6% vs 15.2%) and had higher prevalence of mental health conditions (52.8% vs 30.4%) compared with patients with no criminal justice contact recorded during an ED visit. Of the top 10, four primary diagnoses among patients with criminal justice contact were related to behavioural health conditions, accounting for 19.0% of all primary diagnoses in this population. In contrast, behavioural health conditions were absent from the top 10 primary diagnoses in ED patients with no observed criminal justice contact. Despite a high burden of disease, a lack of health insurance coverage was more common among those with criminal justice contact than those without (41.3% vs 14.1%).
CONCLUSIONS
Given that a large proportion of ED patients with criminal justice contact are frequent users with considerable mental health conditions, current efforts in California's Medicaid programme to identify individuals in need of coordinated services could reduce costly ED utilisation among this group.
目的
评估 2014 年在加利福尼亚州，有刑事司法接触和无刑事司法接触者在急诊科的就诊模式，比较急诊科就诊、就诊频率、诊断和保险覆盖的差异。
设计
回顾性、横断面研究。
设置
分析包括使用加利福尼亚州所有急诊科就诊的全州数据，对所有获准医院的急诊科就诊进行分析。
参与者
研究参与者包括 2014 年至少有一次急诊科就诊的 3757870 名非老年成年急诊科患者。
主要和次要结果
我们评估了有刑事司法接触的急诊科就诊模式和特征——这些患者要么被监狱机构收治入院，要么从急诊科出院——与在急诊科就诊期间没有刑事司法接触记录的患者进行比较。
结果
有刑事司法接触的急诊科患者中频繁就诊者的比例较高（27.2%比 9.4%），急诊科就诊导致住院的风险更高（26.6%比 15.2%），心理健康状况的患病率也更高（52.8%比 30.4%）。与在急诊科就诊期间没有刑事司法接触记录的患者相比，有刑事司法接触的患者中，前 10 大诊断中有 4 个与行为健康状况有关，占该人群所有主要诊断的 19.0%。相比之下，在没有观察到刑事司法接触的急诊科患者中，行为健康状况并未出现在前 10 大主要诊断中。尽管疾病负担沉重，但与没有刑事司法接触的患者相比，有刑事司法接触的患者更常见没有医疗保险（41.3%比 14.1%）。
结论
鉴于有相当多的有刑事司法接触的急诊科患者是频繁就诊者，且有大量心理健康状况，加利福尼亚州医疗补助计划目前正在努力识别需要协调服务的个人，这可能会减少该人群中昂贵的急诊科就诊。
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