McCarthy Melissa L, Zheng Zhaonian, Wilder Marcee E, Elmi Angelo, Li Yixuan, Zeger Scott L
Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
Ann Emerg Med. 2021 May;77(5):511-522. doi: 10.1016/j.annemergmed.2020.11.010. Epub 2021 Mar 11.
We evaluate the relationship between social determinants of health and emergency department (ED) visits in the Medicaid Cohort of the District of Columbia.
We conducted a retrospective cohort analysis of 8,943 adult Medicaid beneficiaries who completed a social determinants of health survey at study enrollment. We merged the social determinants of health data with participants' Medicaid claims data for up to 24 months before enrollment. Using latent class analysis, we grouped our participants into 4 distinct social risk classes based on similar responses to the social determinants of health questions. We classified ED visits as primary care treatable or ED care needed, using the Minnesota algorithm. We calculated the adjusted log relative primary care treatable and ED care needed visit rates among the social risk classes by using generalized linear mixed-effects models.
The majority (71%) of the 49,111 ED visits made by the 8,943 participants were ED care needed. The adjusted log relative rate of both primary care treatable and ED care needed visit rates increased with each higher (worse) social risk class compared with the lowest class. Participants in the highest social risk class (ie, unemployed and many social risks) had a log relative primary care treatable and ED care needed rate of 39% (range 28% to 50%) and 29% (range 21% to 38%), respectively, adjusted for age, sex, and illness severity.
There is a strong relationship between social determinants of health and ED utilization in this Medicaid sample that is worth investigating in other Medicaid samples and patient populations.
我们评估了哥伦比亚特区医疗补助队列中健康的社会决定因素与急诊就诊之间的关系。
我们对8943名成年医疗补助受益人的数据进行了回顾性队列分析，这些受益人在研究入组时完成了一项健康的社会决定因素调查。我们将健康的社会决定因素数据与参与者入组前长达24个月的医疗补助理赔数据进行了合并。通过潜在类别分析，我们根据对健康的社会决定因素问题的相似回答，将参与者分为4个不同的社会风险类别。我们使用明尼苏达算法将急诊就诊分类为初级保健可治疗或需要急诊护理。我们使用广义线性混合效应模型计算了各社会风险类别中经调整的相对初级保健可治疗和需要急诊护理就诊率的对数。
8943名参与者进行的49111次急诊就诊中，大多数（71%）是需要急诊护理的。与最低社会风险类别相比，随着社会风险类别升高（变差），经调整的相对初级保健可治疗和需要急诊护理就诊率的对数均增加。最高社会风险类别（即失业且存在多种社会风险）的参与者，经年龄、性别和疾病严重程度调整后，相对初级保健可治疗就诊率的对数为39%（范围为28%至50%），需要急诊护理就诊率的对数为29%（范围为21%至38%）。
在这个医疗补助样本中，健康的社会决定因素与急诊利用之间存在密切关系，值得在其他医疗补助样本和患者群体中进行研究。
