Fleishman J A, Hsia D C, Hellinger F J
Division of Cost and Financing, Agency for Health Care Policy and Research, Rockville, MD 20852-4908.
Health Serv Res. 1994 Dec;29(5):527-48.
To examine factors affecting the use of inpatient, outpatient, and emergency room services by people with HIV infection.
Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992).
Data on service utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data.
This is an observational study using a panel survey design. Linear and Poisson regression analyses were conducted to determine the effects of need, enabling, and predisposing factors on the dependent variables of ambulatory visits, emergency room visits, inpatient admissions, and average length of inpatient stay. Analyses use 1,449 respondents who completed the second and third interviews. Independent variables were measured as of the second interview, while dependent variables were measured in the third and fourth interview periods.
Service utilization was higher among respondents with AIDS than among those at earlier stages of HIV infection. Functional limitations, experienced pain, and negative mood each were associated with increased service use, over and above disease stage. Black respondents reported more hospital admissions and longer lengths of inpatient stays than white respondents. Lack of insurance was related to reduced service use. The effects of disease stage and functional limitations were reduced among people with public, compared to private, insurance.
While disease stage affects use of medical care, the experience of adverse HIV-related conditions, such as pain or functional limitations, has an additional effect on service use. Persistent racial differences in utilization remain to be explained. Lack of insurance impedes use directly and also modifies the effects of disease stage and functioning.
研究影响艾滋病毒感染者使用住院、门诊和急诊服务的因素。
研究参与者为在美国十个城市的主要医疗服务提供者处接受服务的成年艾滋病毒感染者。在18个月期间（1991年3月至1992年9月）进行了六次访谈。
服务利用情况、个人背景特征、保险状况和功能状况的数据基于自我报告。疾病阶段基于病历数据。
这是一项采用面板调查设计的观察性研究。进行线性和泊松回归分析，以确定需求、促成因素和易患因素对门诊就诊、急诊就诊、住院入院和住院平均时长等因变量的影响。分析使用了1449名完成第二次和第三次访谈的受访者。自变量在第二次访谈时进行测量，而因变量在第三次和第四次访谈期间进行测量。
艾滋病患者的服务利用率高于艾滋病毒感染早期阶段的患者。除疾病阶段外，功能受限、经历疼痛和负面情绪均与服务使用增加相关。黑人受访者报告的住院次数和住院时长均多于白人受访者。缺乏保险与服务使用减少有关。与拥有私人保险的人相比，拥有公共保险的人疾病阶段和功能受限的影响较小。
虽然疾病阶段会影响医疗服务的使用，但与艾滋病毒相关的不良状况（如疼痛或功能受限）的经历对服务使用有额外影响。利用方面持续存在的种族差异仍有待解释。缺乏保险不仅直接阻碍服务使用，还会改变疾病阶段和功能的影响。
