Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, SC, USA.
J Neurol Sci. 2019 Jan 15;396:125-129. doi: 10.1016/j.jns.2018.10.016. Epub 2018 Oct 16.
To evaluate the association between visits to office-based providers and Emergency Department (ED) utilization among stroke survivors.
We analyzed 12-years of data representing a weighted sample of 3,317,794 publicly insured US adults aged ≥18 years with stroke, using the Medical Expenditure Panel Survey Household Component (MEPS-HC), 2003-2014 dataset. We used a negative binomial regression model that accounts for dispersion to estimate the association between office-based and ED visits controlling for covariates. We used a multivariate logistic regression model to identify independent predictors of ED visits.
Annual mean (SD) ED visits and office based visits for publicly insured stroke survivors were 0.60 (1.10) and 12.2 (19.9) respectively. Each unit increase in office based visits was associated with a 1% increase in ED visit (p = 0.008). Being unmarried (adjusted OR = 1.26; 95% CI: 1.015-1.564) and having several comorbidities (adjusted OR = 1.93; 95% CI: 1.553-2.412) were associated with a higher likelihood of at least one ED visit. The odds for an ED visit for individuals aged 45-64, those aged 65 years and above, and those with a college or higher level of education were respectively 34% (OR = 0.66; 95% CI: 0.454-0.965), 52% (OR = 0.48; 95% CI: 0.330-0.701), and 36% (OR = 0.64; 95% CI: 0.497-0.834) lower than their counterparts.
Contrary to our expectations, there was a direct relationship between ED visits and office base visits among U.S. stroke survivors. This finding may reflect the difficulties associated with managing stroke survivors with multiple co-morbidities or complex psycho-socio-economic issues.
评估初级保健提供者就诊与脑卒中幸存者急诊就诊之间的关联。
我们分析了代表 2003-2014 年期间，3317794 名年龄≥18 岁的有保险的美国成年人的加权样本的 12 年数据，该数据来自医疗支出面板调查家庭部分（MEPS-HC）。我们使用负二项回归模型来估计在控制协变量的情况下，初级保健和急诊就诊之间的关联。我们使用多变量逻辑回归模型来确定急诊就诊的独立预测因素。
每年有保险的脑卒中幸存者的平均（标准差）急诊就诊次数和初级保健就诊次数分别为 0.60（1.10）和 12.2（19.9）。每次增加初级保健就诊次数，急诊就诊次数增加 1%（p=0.008）。未婚（调整后的 OR=1.26；95%可信区间：1.015-1.564）和合并多种疾病（调整后的 OR=1.93；95%可信区间：1.553-2.412）与更高的急诊就诊可能性相关。年龄在 45-64 岁、年龄在 65 岁及以上以及具有大学或更高学历的个体发生急诊就诊的几率分别为 34%（OR=0.66；95%可信区间：0.454-0.965）、52%（OR=0.48；95%可信区间：0.330-0.701）和 36%（OR=0.64；95%可信区间：0.497-0.834）低于同龄人。
与我们的预期相反，美国脑卒中幸存者的急诊就诊和初级保健就诊之间存在直接关系。这一发现可能反映了管理患有多种合并症或复杂心理社会经济问题的脑卒中幸存者所面临的困难。
