比较美国农村和城市居民可预防急性护理的使用情况：2008-2017 年全国使用率的观察性研究。
Comparing Preventable Acute Care Use of Rural Versus Urban Americans: an Observational Study of National Rates During 2008-2017.
机构信息
Department of Health Management and Policy and Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University , 3545 Lafayette Ave., Room 362, St. Louis, MO, 63104, USA.
Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute , 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA.
出版信息
J Gen Intern Med. 2021 Dec;36(12):3728-3736. doi: 10.1007/s11606-020-06532-4. Epub 2021 Jan 28.
BACKGROUND
Rural Americans have less access to care than urban Americans. Preventable acute care use is a marker of unmet ambulatory healthcare needs, but little is known about how such utilization has differed between rural and urban areas over time.
OBJECTIVE
Compare preventable emergency department (ED) visit and hospitalization rates among rural versus urban residents over the past decade.
DESIGN
Observational study using a validated algorithm to compute age-sex-adjusted rates per 100,000 individuals of preventable ED visits and hospitalizations. Differences in overall, annual, and condition-specific rates for rural versus urban residents were assessed and linear regression was used to assess 10-year trends.
SETTING
Nationwide Emergency Department Sample, National Inpatient Sample, and US Census, 2008-2017.
PARTICIPANTS
US adults, an annual average of 241.3 million individuals.
MEASUREMENTS
Preventable ED visits and hospitalizations.
RESULTS
Compared to urban residents, rural residents had 45% higher rates of preventable ED visits in 2008 (3003 vs. 2070 per 100,000, adjusted difference [AD]: 933; 95% CI: 928-938) and 44% higher rates of preventable ED visits in 2017 (3911 vs. 2708 per 100,000, AD: 1202; 95% CI: 1196-1208). Rural residents had 26% higher rates of preventable hospitalizations in 2008 (2104 vs. 1666 per 100,000, AD: 439; 95% CI: 434-443) and 13% higher rates in 2017 (1634 vs. 1440 per 100,000, AD: 194; 95% CI: 190-199). Preventable ED visits increased more in absolute terms in rural versus urban residents, but the percentage increase was similar (30% vs. 31%) because rural residents started at a higher baseline. Preventable hospitalizations decreased at a faster rate (22% vs. 14%) among rural versus urban residents.
LIMITATIONS
Observational study; unable to infer causality.
CONCLUSIONS
Rural disparities in acute care use are narrowing for preventable hospitalizations but have persisted for all preventable acute care use, suggesting unmet demand for high-quality ambulatory care in rural areas.
背景
农村居民获得医疗保健的机会少于城市居民。可预防的急性护理使用是未满足的门诊医疗需求的标志，但人们对这种利用在过去十年中如何在农村和城市地区有所不同知之甚少。
目的
比较过去十年农村和城市居民的可预防急诊就诊和住院率。
设计
使用经过验证的算法观察性研究，计算每 10 万人中可预防急诊就诊和住院的年龄性别调整率。评估农村和城市居民的总体、年度和特定疾病的发生率差异，并使用线性回归评估十年趋势。
地点
全国急诊样本、全国住院样本和美国人口普查，2008-2017 年。
参与者
美国成年人，平均每年 2.413 亿人。
测量
可预防的急诊就诊和住院治疗。
结果
与城市居民相比，农村居民 2008 年可预防急诊就诊率高 45%（每 10 万人中 3003 次与 2070 次，调整差异[AD]：933；95%置信区间[CI]：928-938），2017 年可预防急诊就诊率高 44%（每 10 万人中 3911 次与 2708 次，AD：1202；95%CI：1196-1208）。2008 年农村居民可预防住院率高 26%（每 10 万人中 2104 次与 1666 次，AD：439；95%CI：434-443），2017 年高 13%（每 10 万人中 1634 次与 1440 次，AD：194；95%CI：190-199）。农村居民的可预防急诊就诊人数绝对值增加更多，但增幅相似（30%对 31%），因为农村居民的起点更高。农村居民的可预防住院人数下降速度更快（22%对 14%）。
局限性
观察性研究；无法推断因果关系。
结论
农村地区急性护理使用的差异在可预防住院方面正在缩小，但在所有可预防急性护理使用方面仍然存在，这表明农村地区对高质量门诊护理的需求未得到满足。
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