Bagwell Matt T, Wan Thomas T H
Assistant Professor, Division of Public Administration, School of Criminology, Criminal Justice, and Strategic Studies, College of Liberal and Fine Arts, Tarleton State University, RELLIS Academic Alliance Faculty Member, Texas A&M University System (TAMUS), 1425 Bryan Road, RELLIS ACB1, Room 326, Bryan, TX 77807.
Professor, Department of Health Management and Informatics, Doctoral Program in Public Affairs, College of Community Innovation and Education, University of Central Florida, 528 W. Livingston Street, Suite 401, Orlando, FL 32801.
Res Sociol Health Care. 2020;38:49-72. doi: 10.1108/S0275-495920200000038008. Epub 2020 Sep 28.
This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4.
METHODOLOGY/APPROACH: A prospective, longitudinal design was employed to analyze health disparities that potentially exist among RHC Medicare beneficiary patients (+65) in terms of ER use. The years of investigation were 2010 through 2012, using mixed multilevel, binary logistic regression.
This study found that dual eligible RHC patients utilized ER services at higher rates than non-dual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively.
RESEARCH LIMITATIONS/IMPLICATIONS: Regarding limitations, cohort data observations within the window of 3 years were only analyzed; regarding generalizability, in different CMS regions, results will likely vary; and linking other variables together in the study was limited by the accessible data. Future research should consider these limitations, and attempt to refine. The findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socio-economic status, and race continue to influence higher rates of ER utilization in CMS Region 4.
ORIGINALITY/VALUE: In terms of ER utilization disparities, persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 and over may be twice as likely to utilize ER services for care than their counterparts in the Southeastern United States.
本研究分析了医疗保险和医疗补助双重资格以及种族等个体因素对医疗保险和医疗补助服务中心（CMS）第4地区农村医疗诊所（RHC）治疗的老年医疗保险患者急诊室（ER）利用率的影响。
方法/途径：采用前瞻性纵向设计，分析RHC医疗保险受益患者（65岁及以上）在急诊室使用方面可能存在的健康差异。调查年份为2010年至2012年，使用混合多层次二元逻辑回归分析。
本研究发现，具有双重资格的RHC患者使用急诊室服务的比例高于仅具有医疗保险资格的非双重资格RHC患者，2010年、2011年和2012年的比例分别为77%、80%和66%；与白人参照组相比，黑人RHC医疗保险患者使用急诊室服务的比例更高，2010年、2011年和2012年的比例分别为18%、20%和34%。
研究局限性/启示：关于局限性，仅分析了3年内的队列数据观察结果；关于普遍性，在不同的CMS地区，结果可能会有所不同；研究中其他变量的关联受到可获取数据的限制。未来的研究应考虑这些局限性，并尝试加以改进。研究结果支持，医疗保险和医疗补助双重资格作为社会经济地位的替代指标，以及种族因素，继续影响CMS第4地区较高的急诊室利用率。
原创性/价值：在急诊室利用差异方面，一直到2012年，65岁及以上具有双重资格的黑人RHC医疗保险受益患者使用急诊室服务进行治疗的可能性可能是美国东南部同类患者的两倍。
