Department of Computing Sciences, Texas A&M University - Corpus Christi, Corpus Christi, TX, USA.
Department of Psychology and Sociology, Texas A&M University - Corpus Christi, Corpus Christi, TX, USA.
Public Health. 2019 Apr;169:76-83. doi: 10.1016/j.puhe.2019.01.005. Epub 2019 Feb 28.
Ambulatory care sensitive condition (ACSC) admission rates have been widely used as indicators of access to and quality of primary care as well as the efficiency of health systems. This study examines associations of spatial access to health care with both inpatient hospital admissions and emergency department (ED) visits for ACSCs for older adults. This study also compares inpatient hospitalization admissions and ED visits for elderly ACSCs by spatial access to health care.
This is a complete hospital discharge dataset study.
Hospital discharge data were obtained from all hospital systems in the Coastal Bend area of Texas from September 1, 2009, to August 31, 2012. The enhanced two-step floating catchment area method was adopted to measure spatial access to health care, including primary health care and hospitals. Multivariable regression methods were used to measure the associations between spatial access to health care and ACSC rates of both inpatient hospitalizations and ED visits.
Spatial access to primary care has a statistically significant positive relationship with both rates of inpatient hospitalization admissions and ED visits for ACSCs for the elderly. Spatial access to hospitals has a statistically significant negative relationship with both rates. Spatial access to primary care has a significantly negative contribution to the likelihood of inpatient hospitalizations compared with the likelihood of ED visits for elderly ACSCs, whereas spatial access to hospitals has a significantly positive contribution.
Spatial access to health care contributes to elderly ACSC hospitalizations. A poorer access to primary care or a better access to hospitals increases both rates of inpatient hospitalizations and ED visits for elderly ACSCs. Seniors living in areas where residents had poor access to primary care or easy access to hospitals were more likely to visit EDs instead of being inpatients for ACSC conditions. Policy action is needed to improve spatial access to primary care for the elderly.
门诊护理敏感条件（ACSC）入院率已被广泛用作评估初级保健的可及性和质量以及卫生系统效率的指标。本研究考察了老年人获得医疗保健的空间可达性与住院和急诊部门（ED）就诊 ACSC 之间的关联。本研究还比较了老年人 ACSC 住院和 ED 就诊的空间可达性。
这是一项完整的医院出院数据集研究。
从 2009 年 9 月 1 日至 2012 年 8 月 31 日，从德克萨斯州海岸弯地区的所有医院系统中获取了住院数据。采用增强两步浮动集水区法测量医疗保健的空间可达性，包括初级保健和医院。采用多变量回归方法测量医疗保健空间可达性与 ACSC 住院率和 ED 就诊率之间的关联。
与老年人 ACSC 的住院率和 ED 就诊率相比，初级保健的空间可达性具有统计学上显著的正相关关系。医院的空间可达性与这两个比率均呈统计学上显著负相关。与 ED 就诊相比，初级保健的空间可达性对老年人 ACSC 的住院可能性有显著的负贡献，而医院的空间可达性有显著的正贡献。
医疗保健的空间可达性对老年人 ACSC 的住院有贡献。初级保健可达性较差或医院可达性较好会增加老年人 ACSC 的住院率和 ED 就诊率。居住在初级保健可达性差或医院可达性好的地区的老年人更有可能因 ACSC 就诊而到 ED 就诊，而不是住院。需要采取政策行动改善老年人的初级保健空间可达性。
