"Narrowing the Gap"
2000; American Medical Association; Volume: 154; Issue: 8 Linguagem: Inglês
10.1001/archpedi.154.8.791
ISSN1538-3628
AutoresMark Piehl, Conrad J. Clemens, Jerry D. Joines,
Tópico(s)Medical Malpractice and Liability Issues
ResumoObjective: To evaluate the effectiveness of increased primary care access created by North Carolina's Medicaid managed care plan, Carolina Access (CA), in reducing unnecessary emergency department (ED) use in Guilford County.Methods: Emergency department records of pediatric visits before and after the implementation of CA were analyzed.Variables included patient age, International Classification of Diseases, Ninth Revision discharge diagnosis, insurance status, date of visit, time of visit, and ZIP code.Visits were classified as either urgent or nonurgent based on discharge diagnosis.Rates of ED use per 1000 persons were calculated using county population and Medicaid enrollment figures.Results: A total of 54 742 ED visits occurred between January 1, 1995, and December 31, 1997.Thirty-eight percent of these visits were by children (defined as those aged 0-18 years in this study) enrolled in the Medicaid program.After the implementation of CA, monthly ED rates per 1000 children with Medicaid insurance decreased 24% from 33.5±5.3 to 25.6±2.3(PϽ.001), which
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