| Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. For the Rapid Early Action for Coronary Treatment (REACT) Study. | |
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MedLine Citation:
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PMID: 10828770 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both. METHODS: This study uses a subset of baseline data from the REACT trial, a multicenter, randomized controlled community trial designed, in part, to increase EMS use. The sample includes 860 consecutive noninstitutionalized patients (>30 years old) presenting with nontraumatic chest discomfort to hospital emergency departments in 4 Oregon/Washington communities. The association between prepayment systems and EMS use was analyzed using multivariable logistic regression. RESULTS: Overall EMS use was 52% (n=445). Among EMS users, 338 (75%) were subsequently admitted to the hospital and 110 (25%) were released from the ED. Prepayment was not associated with increased EMS use in the overall patient sample. However, patients residing in low-income census block groups (median annual income <$30,000) were 2.6 times (95% confidence interval [CI] 1.4 to 4.8) more likely to use EMS when a prepayment system was available than when no system was present. No association was noted among higher-income block group residents. Among low-income block group residents lacking private insurance, prepayment systems were associated with 3.8 times (95% CI 1.2 to 13.4) greater EMS usage. CONCLUSION: Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups. |
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Authors:
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D B Siepmann; N C Mann; J R Hedges; M R Daya |
Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Annals of emergency medicine Volume: 35 ISSN: 0196-0644 ISO Abbreviation: Ann Emerg Med Publication Date: 2000 Jun |
Date Detail:
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Created Date: 2000-06-26 Completed Date: 2000-06-26 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 573-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Oregon Health Sciences University, Portland, OR, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Chest Pain / economics, epidemiology*, etiology Emergency Service, Hospital / economics, utilization* Female Health Services Misuse / economics, statistics & numerical data Humans Male Middle Aged Oregon Prepaid Health Plans / economics, utilization* Socioeconomic Factors Uncompensated Care / economics, statistics & numerical data Utilization Review Washington |
| Grant Support | |
ID/Acronym/Agency:
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HL53141-03/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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