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Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain

ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 481-490页

作者： Govindarajan, A Schull, M Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON M4N 3M5 Canada Univ Toronto Fac Med Toronto ON Canada

Study objective: The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain. Methods: A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region. Results: Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds;95% confidence interval [Cl] 6.2 to 70.9 seconds) and transport interval (132.3 seconds;95% Cl 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years;95% Cl 13.3 to 75.1 seconds), female sex (+205.0 seconds;95% C1 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds;95% Cl 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities. Conclusion: High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and a

关键词：急救医疗服务/经济学急救医疗服务/统计学和数值数据卫生服务研究收入/统计学和数值数据安大略贫困区试验预期值回归分析居住特征/统计学和数值数据回顾性研究疾病严重程度指数性别因素社会阶级时间因素病人转送/经济学病人转送/统计学和数值数据女(雌)性人类男(雄)性中年人

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Inappropriate use of an accident and emergency department:: Magnitude, associated factors, and reasons -: An approach with explicit criteria

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 568-579页

作者： Sempere-Selva, T Peiró, S Sendra-Pina, P Martínez-Espín, C López-Aguilera, I Fdn Inst Invest Serv Salud Valencia 46008 Spain Hosp Morales Meseguer Serv Urgencias Murcia Spain Hosp Gen Univ Serv Urgencias Elche Spain

Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

关键词：年龄因素住院期间审核交叉研究诊断相关患者组/分类诊断相关患者组/统计学和数值数据急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究医院公立/利用医院大学/利用病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据初级卫生保健/利用问卷调查转诊和会诊/组织和管理居住特征/统计学和数值数据危险因素疾病严重程度指数西班牙/流行病学运输/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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Report of the task force on residency training information (2000-2001), American Board of Emergency Medicine

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ANNALS OF EMERGENCY MEDICINE 2001年第5期37卷 515-532页

作者： Hoffman, GL Bock, BF Gallagher, EJ Ham, HP Reinhart, MA Amer Board Emergency Med Task Force Residency Training Informat E Lansing MI 48823 USA

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the fourth annual report on the status of US emergency... 详细信息

关键词：聘任鉴定/统计学和数值数据年龄分布课程教育医学研究生/统计学和数值数据教育医学研究生/发展趋势急救医学/教育人种群/统计学和数值数据助学金和奖学金/组织和管理实习医师和住院医师职务/统计学和数值数据实习医师和住院医师职务/发展趋势许可证医学居住特征/统计学和数值数据时间因素美国成年人女(雌)性人类男(雄)性中年人

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Role of parkin mutations in 111 community-based patients with early-onset parkinsonism

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ANNALS OF NEUROLOGY 2002年第5期51卷 621-625页

作者： Kann, M Jacobs, H Mohrmann, K Schumacher, K Hedrich, K Garrels, J Wiegers, K Schwinger, E Pramstaller, PP Breakefield, XO Ozelius, LJ Vieregge, P Klein, C Med Univ Lubeck Neurol Klin Dept Neurol D-23538 Lubeck Germany Med Univ Lubeck Dept Human Genet D-23538 Lubeck Germany Hosp Rothenburg Wumme Dept Neurol Rothenburg Germany Gen Reg Hosp Bolzano Dept Neurol Bolzano Italy Massachusetts Gen Hosp Dept Neurol Mol Neurogenet Unit Boston MA 02114 USA Harvard Univ Sch Med Dept Neurol Boston MA 02115 USA Albert Einstein Coll Med Dept Mol Genet Bronx NY 10467 USA Lippe Lemgo Hosp Lemgo Germany

Early-onset parkinsonism is frequently reported in connection with mutations in the parkin gene. In this study, we present the results of extensive genetic screening for parkin mutations in 111 community-derived early-onset parkinsonism patients (age of onset <50 years) from Germany with an overall mutation rate of 9.0%. Gene dosage alterations represented 67% of the mutations found, underlining the importance of quantitative analyses of parkin. In summary, parkin mutations accounted for a low but significant percentage of early-onset parkinsonism patients in a community-derived sample.

关键词：发病年龄外显子/遗传学连接酶类/遗传学突变/遗传学帕金森障碍/遗传学居住特征/统计学和数值数据泛素蛋白连接酶类成年人女(雌)性人类男(雄)性中年人

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Invited commentary: Advancing theory and methods for multilevel models of residential neighborhoods and health

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AMERICAN JOURNAL OF EPIDEMIOLOGY 2003年第1期157卷 9-13页

作者： O'Campo, P Johns Hopkins Bloomberg Sch Publ Hlth Dept Populat & Family Hlth Sci Baltimore MD 21205 USA Johns Hopkins Bloomberg Sch Publ Hlth Dept Epidemiol Baltimore MD 21205 USA

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Addressing cultural competency in research: Integrating a community-based participatory research approach

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ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH 2003年第8期27卷 1361-1364页

作者： Shiu-Thornton, S Univ Washington Sch Publ Hlth & Community Med Dept Hlth Serv Seattle WA 98195 USA

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The relationship between the geographic density of alcohol outlets and alcohol-related hospital admissions in San Diego County

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JOURNAL OF COMMUNITY HEALTH 2000年第1期25卷 79-88页

作者： Tatlow, JR Clapp, JD Hohman, MM San Diego State Univ Sch Social Work San Diego CA 92182 USA San Diego State Univ Sch Publ Hlth San Diego CA 92182 USA

Increasing concerns regarding the cost of medical care have led to research that has found a relationship between alcohol abuse, increased medical problems, longer hospital stays, and higher medical costs. Research has also found a positive relationship between alcohol availability and crime, car accidents, and liver cirrhosis deaths. One area of interest is how alcohol availability, as measured by the number of alcohol outlets, is related to medical care needs. The purpose of this study was to examine the relationship between the geographic density of alcohol outlets and the number of alcohol-related hospital admissions. alcohol-related ICD-9 codes were selected based on epidemiologic research in the literature to determine alcohol-related morbidity from the California Discharge Data System, which collects information on all hospital admissions and discharges in California. In San Diego County, in 1996, 3,759 admissions were alcohol-related. Alcohol-related admissions for each zip code were compared to the number of liquor licenses that were held by each zip code through a multiple regression analysis. The regression model demonstrated that the number of liquor outlets was a significant predictor of alcohol-related hospital admissions, net of other predictors. Implications are discussed, including regulation of alcohol availability, which may have a beneficial impact on alcohol morbidity.

关键词：年龄分布酒精性饮料/供应和分配酒精中毒/流行病学酒精中毒/病因学加利福尼亚/流行病学商业/统计学和数值数据诊断相关患者组/统计学和数值数据最小二乘法分析许可证/统计学和数值数据年患病率多元分析需求估价病人入院/统计学和数值数据试验预期值居住特征/统计学和数值数据危险因素性别分布成年人老年人女(雌)性人类男(雄)性中年人

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What we say and what we do: County-level public spending for health care

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 421-430页

作者： Zimmerman, MK McAdams, R Univ Kansas Dept Hlth Policy & Management Overland Pk KS 66213 USA

The purpose oft his study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

关键词：预算筹资政府/经济学卫生卫生经费支出/统计学和数值数据卫生服务/经济学收入堪萨斯模型经济计量学人口密度问卷调查居住特征/统计学和数值数据人类

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Health Insurance Coverage and Use of Services Among Low‐Income Elders:Does Residence Influence the Relationship?

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The Journal of Rural Health 1995年第2期11卷 86-97页

作者： Seccombe, Karen Department of Sociology and the Institute for Health Policy Research University of Florida Gainesville Florida 32611 3219 Turlington Hall United States

Abstract: This research uses a nationally representative sample of 1,425 low‐income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare;(b) those who lived in nonmetropoli‐tan areas use fewer health services;and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low‐income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services;the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low‐income elders. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：卫生服务范围/统计学和数值数据卡方分布数据收集老年人保健服务/利用保险健康/利用 Medicaid/利用 Medicare/利用多元分析贫困/统计学和数值数据居住特征/统计学和数值数据农村人口美国市区人口老年人女(雌)性人类男(雄)性

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A Multivariate Assessment of the Effects of Residence on Infant Mortality

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The Journal of Rural Health 1991年第3期7卷 246-265页

作者： Clarke, Leslie L. Coward, Raymond T. Center for Health Policy Research J. Hillis Miller Health Sciences Center University of Florida Gainesville Florida 32610-0177 Box J-177 United States

ABSTRACT: This research examines the relationship between residence and infant mortality. The purpose of the study was to identify the effects of maternal residence on infant mortality, using a multivariate model which included both individual and county‐level variables known to be associated with suboptimal birth outcome. Data on all births in Florida during 1987 were drawn from birth and infant death certificates. In addition, information concerning county sociodemographic structure and medical resources were gathered and linked to the individual records. After examining the distributions of selected risk variables across a five‐category measure of residence (from most urban to most rural), a logit model was estimated to predict the odds of an infant death associated with maternal residence. At the bivariate level, rural residents were found to have increased odds of an infant death compared to residents of all other residence categories. Second, a logit model was estimated that controlled for the influence of important maternal, infant, and county risk characteristics. The results of this second, more fully specified model indicate that residence did not have an independent direct effect on infant mortality when the influence of the other risk factors was controlled. We conclude that although residence does not influence infant mortality directly, it does influence mortality indirectly through its association with key risk factors. In particular, because population characteristics and medical resources are differentially distributed across rural and urban areas, residence remains an important factor to be considered when predicting health outcomes. The implications of these findings for polcy‐makers and health planners, as well as for health services researchers, are also discussed. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：佛罗里达健康计划婴儿死亡率 Logistic模型母亲/统计学和数值数据多元分析居住特征/统计学和数值数据危险因素农村卫生/统计学和数值数据人类婴儿

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