Billittier A J, Moscati R, Janicke D, Lerner E B, Seymour J, Olsson D
State University of New York at Buffalo, Department of Emergency Medicine, USA.
Acad Emerg Med. 1996 Nov;3(11):1046-52. doi: 10.1111/j.1553-2712.1996.tb03352.x.
To determine the social and demographic factors associated with medically unnecessary ambulance utilization, and to determine the willingness of patients to use alternate modes of transportation to the ED.
A multisite prospective survey was conducted of all patients arriving by ambulance to 1 suburban and 4 urban EDs in New York State during a 1-week period.
For 626 patients surveyed, 71 (11.3%) transports were judged medically unnecessary by the receiving emergency physicians using preestablished guidelines. The patient's type of medical insurance and age were significant predictors of unnecessary ambulance transport (stepwise forward logistic regression analysis). Of the 71 patients whose ambulance transports were deemed medically unnecessary, 42 (59%) were Medicaid recipients and 53 (74%) were < 40 years of age. The most common reason for using ambulance transport was lack of an alternate mode of transportation (38.5%), although 82% would have been willing to use an alternate mode of transportation if it had been available. Of those who had medically unnecessary ambulance use, 30% indicated that they would not pay for the ambulance service if billed and 50% believed the cost of their ambulance transports was < $100. More than 85% of the patients whose ambulance transports were deemed medically unnecessary were unemployed; and nearly 85% reported a net annual income of < $20,000. While 33% had a primary care provider, only 22% had attempted to contact their doctors before requesting an ambulance.
Patient age < 40 years and Medicaid coverage were associated with medically unnecessary ambulance use. Those patients for whom ambulance use was considered medically unnecessary commonly had no alternate means of transportation. Providing alternate means of unscheduled transportation may reduce the incidence of unnecessary ambulance use.
确定与非必要医疗救护车使用相关的社会和人口因素，并确定患者使用其他交通方式前往急诊科的意愿。
在一周时间内，对纽约州1家郊区和4家城市急诊科所有乘坐救护车前来的患者进行了多地点前瞻性调查。
在接受调查的626名患者中，根据既定指南，接收的急诊医生判定71例（11.3%）转运为非必要医疗转运。患者的医疗保险类型和年龄是非必要救护车转运的重要预测因素（逐步向前逻辑回归分析）。在71例被判定为非必要医疗救护车转运的患者中，42例（59%）是医疗补助计划的受益者，53例（74%）年龄小于40岁。使用救护车转运最常见的原因是没有其他交通方式（38.5%），尽管如果有其他可用的交通方式，82%的患者愿意使用。在那些非必要医疗使用救护车的患者中，30%表示如果收到账单不会支付救护车服务费用，50%认为其救护车转运费用低于100美元。超过85%的被判定为非必要医疗救护车转运的患者失业；近85%的患者报告年净收入低于20,000美元。虽然33%的患者有初级保健医生，但只有22%的患者在请求救护车之前尝试联系过他们的医生。
年龄小于40岁的患者和医疗补助计划覆盖与非必要医疗救护车使用相关。那些被认为非必要医疗使用救护车的患者通常没有其他交通方式。提供非预定的其他交通方式可能会降低非必要救护车使用的发生率。
