Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, Ohio.
J Rural Health. 2021 Jun;37(3):479-486. doi: 10.1111/jrh.12484. Epub 2020 Aug 3.
The current study examines rural-urban differences in trends in rates and type of concussion-related health care utilization over time from 2008 to 2016 among Medicaid insured children in Ohio.
We analyzed Medicaid claims for health care utilization for diagnosed concussions among children aged ≤18 years between April 1, 2008, and December 31, 2016. We compared the trends in rates of concussion-related health care utilization between children who lived in rural and urban areas using Poisson regressions. We examined trends in the type of concussion-related health care utilization by location of residence using linear regressions.
We found a significant increase in health care utilization for concussion over time, with rates of treated concussion consistently higher in rural children compared to urban children (P < .0001) throughout the study period. Although initial care at the Emergency Department (ED) remained the most common type of initial concussion-related health care utilization for rural children throughout the study period, the most common type of initial care sought by urban children shifted over time from the ED to primary care providers (PCPs). For both rural and urban children, PCPs remained the most common type of follow-up care sought throughout the study period, with no significant rural-urban differences in the trends of follow-up care sought through PCPs over time.
We observed significant rural-urban differences in the trends in rates and types of concussion-related health care utilization over time from 2008 to 2016. Future studies are needed to further our understanding of the effect of these observed rural-urban differences on concussion recovery.
本研究旨在考察俄亥俄州医疗补助保险儿童在 2008 年至 2016 年期间，农村和城市地区随时间推移的脑震荡相关医疗保健利用趋势的城乡差异。
我们分析了 2008 年 4 月 1 日至 2016 年 12 月 31 日期间，年龄≤18 岁的患有脑震荡的医疗补助保险儿童的医疗保健利用情况。我们使用泊松回归比较了居住在农村和城市地区的儿童的脑震荡相关医疗保健利用率的趋势。我们通过居住地检查了脑震荡相关医疗保健利用类型的趋势。
我们发现，随着时间的推移，脑震荡的医疗保健利用率显著增加，在整个研究期间，农村儿童的治疗性脑震荡率始终高于城市儿童（P <.0001）。尽管农村儿童的初始治疗仍以急诊科（ED）就诊为主，但城市儿童的初始治疗类型在整个研究期间逐渐从 ED 向初级保健提供者（PCP）转移。对于农村和城市的儿童来说，PCP 一直是最常见的后续脑震荡相关医疗保健利用类型，在整个研究期间，PCP 的后续护理利用率没有明显的城乡差异。
我们观察到，2008 年至 2016 年期间，农村和城市地区的脑震荡相关医疗保健利用率趋势存在显著的城乡差异。需要进一步的研究来深入了解这些观察到的城乡差异对脑震荡恢复的影响。
