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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Association of lower continuity of care with greater risk of emergency department use and hospitalization in children.
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Association of lower continuity of care with greater risk of emergency department use and hospitalization in children.

机译：护理连续性较低与儿童急诊室使用和住院的更大风险相关。

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CONTEXT: The benefits of continuity of pediatric care remain controversial. OBJECTIVE: To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and decreased risk of emergency department (ED) visitation and hospitalization. DESIGN: Retrospective cohort study. Setting and Population. We used claims data from 46 097 pediatric patients enrolled at Group Health Cooperative, a large staff-model health maintenance organization, between January 1, 1993, and December 31, 1998, for our analysis. To be eligible, patients had to have been continuously enrolled for at least a 2-year period or since birth and to have made at least 4 visits to one of the Group Health Cooperative clinics. MAIN EXPOSURE VARIABLE: A continuity of care (COC) index that quantifies the degree to which a patient has experienced continuous care with a provider. MAIN OUTCOME MEASURES: ED utilization and hospitalization. RESULTS: Compared with children with the highest COC, children with medium continuity were more likely to have visited the ED (hazard ratio [HR]: 1.28 [1.20-1.36]) and more likely to be hospitalized (HR: 1.22 [1.09-1.38]). Children with the lowest COC were even more likely to have visited the ED (HR: 1.58 [1.49-1.66]) and to be hospitalized (HR: 1.54 [1.33-1.75]). These risks were even greater for children on Medicaid and those with asthma. CONCLUSIONS: Lower continuity of primary care is associated with higher risk of ED utilization and hospitalization. Efforts to improve and maintain continuity may be warranted.
机译：语境：儿科护理连续性的好处仍存在争议。目的：确定与初级保健儿科医师之间的持续关系与急诊就诊和住院风险的降低之间是否存在关联。设计：回顾性队列研究。设置和人口。我们使用了1993年1月1日至1998年12月31日期间加入大型团体健康维护组织Group Health Cooperative的46 097名儿科患者的索赔数据进行分析。为了符合资格，患者必须连续入选至少2年或自出生以来入组，并且必须至少访问过4家团体健康合作诊所之一。主要暴露变量：护理连续性（COC）指数，用于量化患者与提供者进行连续护理的程度。主要观察指标：ED的使用和住院治疗。结果：与COC最高的儿童相比，中度连续性儿童更容易去过ED（危险比[HR]：1.28 [1.20-1.36]）和住院的可能性更高（HR：1.22 [1.09-1.38] ]）。 COC最低的儿童更有可能去过急诊科（HR：1.58 [1.49-1.66]）并住院（HR：1.54 [1.33-1.75]）。对于使用Medicaid的儿童和患有哮喘的儿童，这些风险甚至更大。结论：较低的初级保健连续性与较高的ED利用和住院风险有关。可能需要努力改善和保持连续性。

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