Hospital Costs and Reimbursement Model for a Geriatric Emergency Department.
Hospital Costs and Reimbursement Model for a Geriatric Emergency Department.
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DOI：
10.1111/acem.13998
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Archual G
中科院分区：
文献类型：
--
作者：
Southerland LT;Savage EL;Muska Duff K;Caterino JM;Bergados TR;Hunold KM;Finnegan GI;Archual G
美国急诊医师学会的老年急诊科 (GED) 指南建议增加人员和老年科设备，但这对于每个急诊科来说在经济上可能并不可行。来自经认可的 1 级 GED 的数据用于报告设备成本并开发 GED 财务可持续性的商业模式。包括附加福利费用在内的员工工资是从一家中西部医院获得的，该医院的学术急诊室年就诊次数为 80,000 人次。报销假设包括 100% Medicare/Medicaid 保险付款人以及 8 小时工作日和每年 4.5 周的休假。对医院发票中的设备成本进行了核对。比较 GED 前后的操作和患者安全指标。急诊科的老年科执业护士在经济上可以自给自足，咨询次数为 7.1 次；药剂师在药物协调咨询次数为 7.7 次，财务自给自足；物理治疗师和职业治疗师评估在每个工作日分别为 5.7 次和 4.6 次咨询，可以自给自足。 GED 的行动辅助器具、谵妄辅助器具、感觉辅助器具和个人护理用品的年度设备总成本为 4,513 美元。对比前后两年，运行指标方面，住院时间>8小时的患者和留观患者的比例没有变化。在患者安全方面，急诊科观察室的跌倒率从 0.60/1,000 例患者减少到 0.42/1,000 例，急诊室的跌倒率从 0.42/1,000 例下降到 0.36/1,000 例。 7 天和 30 天的 ED 累犯情况没有变化。减少跌倒次数预计可节省 80,328 美元的成本。急诊室进行全面老年病评估所需的额外设备和人员成本可能会因创收和患者安全措施的改善而在财务上合理。老年急诊科与急诊科患者跌倒的减少有关，但并没有减少入院率或急诊科累犯率。
The American College of Emergency Physicians’ Geriatric Emergency Department (GED) Guidelines recommend additional staff and geriatric equipment, which may not be financially feasible for every ED. Data from an accredited level 1 GED was used to report equipment costs and to develop a business model for financially sustainability of a GED. Staff salaries including the cost of fringe benefits were obtained from a Midwestern hospital with an academic ED of 80,000 annual visits. Reimbursement assumptions included 100% Medicare/Medicaid insurance payor and 8 hour workdays with 4.5 weeks of leave annually. Equipment costs from hospital invoices were collated. Operational and patient safety metrics were compared before and after the GED. A Geriatric nurse practitioner in the ED is financially self-sustaining at 7.1 consultations, a pharmacist is self-sustaining at 7.7 medication reconciliation consultations, and physical and occupational therapist evaluations are self-sustaining at 5.7 and 4.6 consults per workday respectively. Total annual equipment costs for mobility aids, delirium aids, sensory aids, and personal care items for the GED was $4,513. Comparing the two years before and after, in regards to operational metrics the proportions of patients with lengths of stay > 8 hours and patients placed in observation did not change. In regards to patient safety, the rate of falls decreased from 0.60/1,000 patient visits to 0.42/1,000 in the ED Observation Unit and 0.42/1,000 to 0.36/1,000 in the ED. ED recividism at 7 and 30 days did not change. Estimated cost savings from the reduction in falls was $80,328. The additional equipment and personnel costs for comprehensive geriatric assessment in the ED are potentially financially justified by revenue generation and improvements in patient safety measures. A Geriatric ED was associated with a decrease in patient falls in the ED but did not decrease admissions or ED recidivism.
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影响因子：
6.3
作者：
Hwang U;Dresden SM;Rosenberg MS;Garrido MM;Loo G;Sze J;Gravenor S;Courtney DM;Kang R;Zhu CW;Vargas-Torres C;Grudzen CR;Richardson LD;GEDI WISE Investigators
通讯作者：
GEDI WISE Investigators
影响因子：
6.3
作者：
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Merchant, Roland C.
影响因子：
9.7
作者：
Grudzen, Corita;Richardson, Lynne D.;Hwang, Ula
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影响因子：
6.2
作者：
Southerland, Lauren T.;Lo, Alexander X.;Carpenter, Christopher R.
通讯作者：
Carpenter, Christopher R.
影响因子：
1.7
作者：
Terrell, Kevin M.;Weaver, Christopher S.;Ross, Mary J.
通讯作者：
Ross, Mary J.