Department of Family and Community Health, University of Maryland School of Nursing, Rockville, Maryland, USA.
West J Nurs Res. 2020 Jul;42(7):503-513. doi: 10.1177/0193945919867938. Epub 2019 Aug 2.
The use of emergency departments (EDs) for potentially preventable visits is costly and inefficient. In Maryland, about 20%-30% of such visits are ambulatory care sensitive and thus potentially preventable. The uninsured are often perceived to account for a disproportionate share of such visits. This analysis aimed to (a) compare and explain the geographic variance in Maryland's potentially preventable ED visit (PPV) rates for the total and uninsured populations and (b) test the predictive value of regression models developed. Geographic hot spots of increased PPV rates were highly correlated for uninsured and total populations, but uninsured rates were more clustered in urban areas. Poisson and geographically weighted regression (GWR) models best fit the data and predicted 40%-52% and 46% of the variance in 2009 total and uninsured rates, respectively. Significant predictors of increased PPV rates were social determinants of health: lower per capita income and education levels, and higher percentage of female-headed households.
急诊科（ED）的使用对于潜在可预防的就诊是昂贵且低效的。在马里兰州，大约 20%-30%的此类就诊属于可通过门诊治疗的疾病，因此是潜在可预防的。无保险人群往往被认为占此类就诊的不成比例的部分。本分析旨在（a）比较和解释马里兰州全人群和无保险人群潜在可预防 ED 就诊率（PPV）的地域差异，并（b）检验所开发的回归模型的预测价值。对于无保险和全人群而言，就诊率增加的高热点区域具有高度相关性，但无保险率在城市地区更为集中。泊松和地理加权回归（GWR）模型最适合数据，分别预测了 2009 年全人群和无保险人群就诊率的 40%-52%和 46%的方差。就诊率增加的显著预测因素是健康的社会决定因素：人均收入和教育水平较低，女性户主家庭比例较高。
