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Determinants of Pediatric EMS Utilization in Children with High-Acuity Conditions

机译：高痛苦条件儿童儿科eMS利用的决定因素

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Background: Underutilization of emergency medical services (EMS) for children with high-acuity conditions is poorly understood. Our objective was to identify differences in demographic factors and describe caregivers' knowledge, beliefs, and attitudes regarding EMS utilization for children with high-acuity conditions. Design/Methods: This was a mixed-methods study of children with high acuity conditions, defined as requiring immediate medical or surgical intervention and intensive care admission, over a one year period. Demographic data were collected through a retrospective chart review. Qualitative analysis of semi-structured interviews from a purposive sample of caregivers was conducted until thematic saturation was achieved. Results: Three hundred seventy-four charts were reviewed; 19 caregivers were interviewed (17 in-person, 2 via telephone). The 232 (62%) children not arriving by EMS tended to be younger (1.58 years vs. 2.31 years, p = 0.02), privately insured (30% vs. 19%, p = 0.04), and lived further from the hospital (16.80 miles vs. 12.45 miles, p = 0.001). Patient gender, ethnicity, comorbidities and caregiver language were not associated with EMS underutilization. Immediate invasive medical interventions were more often required for EMS utilizers (85% vs. 60%, p 0.001). EMS utilizers were more likely to require intubation (78% vs. 47%, p 0.001) and cardiopulmonary resuscitation (CPR) (26% vs. 2%, p 0.001), and had shorter hospital stays (4.70 vs. 8.16 days; p-value 0.001). Three principal themes determined EMS utilization: expectations, knowledge, and perceived barriers. Three principal themes determined EMS utilization: expectations, knowledge, and perceived barriers. Caretakers expected EMS would provide timely, safe transportation that expedited medical care and emotional support. Medical knowledge and prior experience with EMS influenced decision-making about arrival mode. Timeliness, cost, socioeconomic and demographic characteristics, loss of autonomy, and the logistics of EMS activation and transport were the most commonly reported barriers. Conclusions: Young age, private insurance status, and greater distance from the hospital were associated with EMS underutilization. Understanding caregiver expectations, knowledge, and perceived barriers may have important implications for the use of EMS for children. These findings reveal opportunities for improved public education on EMS systems to enhance appropriate EMS utilization for children with high acuity conditions.
机译：背景：高敏感条件的儿童紧急医疗服务（EMS）的未充分理解。我们的目标是确定人口统计因素的差异，并描述了关于具有高敏锐条件的儿童EMS利用的护理人员的知识，信念和态度。设计/方法：这是一种混合方法，对具有高敏锐度条件的儿童的综合研究，定义为需要立即医疗或外科干预和重症监护入学的一年。通过回顾性图表审查收集人口统计数据。进行了来自护理人员目的样本的半结构化访谈的定性分析，直到实现了主题饱和度。结果：审查了三百七十四条图表; 19名护理人员进行了采访（17人，2人，通过电话2）。 232（62％）EMS抵达的儿童往往更年轻（1.58年与2.31岁，P = 0.02），私下被保险（30％与19％，P = 0.04），并从医院进一步生活（ 16.80英里与12.45英里，p = 0.001）。患者性别，种族，合并症和护理人员与EMS未充分利用无关。 EMS利用者（85％vs.60％，P <0.001）更常见立即侵入性医疗干预措施。 EMS利用者更有可能需要插管（78％vs.47％，P <0.001）和心肺复苏（CPR）（26％vs.2％，P <0.001），并具有较短的医院住宿（4.70 Vs. 8.16天; p值<0.001）。三个主要主题确定了EMS利用：期望，知识和感知障碍。三个主要主题确定了EMS利用：期望，知识和感知障碍。 Caretakers预期的EMS将提供及时，安全的运输，加快医疗和情感支持。医学知识和对EMS的事先经验影响到达到达模式的决策。及时性，成本，社会经济和人口特征，自主丧失以及EMS激活和运输的物流是最常见的障碍。结论：年轻时，私人保险状况以及距离医院的距离更远，与EMS未充分利用有关。了解护理人员的期望，知识和感知障碍可能对儿童的EMS使用EMS可能具有重要意义。这些调查结果揭示了改善EMS系统公共教育的机会，以加强适当的EMS利用高敏锐度条件的儿童。

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