Costs of ED episodes of care in the United States
Costs of ED episodes of care in the United States
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DOI：
10.1016/j.ajem.2015.06.001
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发表时间：
2016-03-01
影响因子：
3.6
通讯作者：
Pines, Jesse M.
中科院分区：
文献类型：
--
作者：
Galarraga, Jessica E.;Pines, Jesse M.
背景：急诊科（艾德）护理是降低成本努力的重点。源自艾德的急症护理费用，包括门诊和住院就诊目的：我们估计美国艾德发作的总成本，潜在可避免的成本，以及国家卫生支出（NHE）的比例成本。我们对2010年医疗支出小组调查、全国医院门诊医疗调查、和医疗保健成本和利用项目的全国住院病人样本。根据纽约大学的算法和门诊护理敏感性疾病（ACSC）与非ACSC的入院情况对门诊艾德就诊进行分类。可能避免的接触是非紧急艾德就诊和ACSC住院。使用医疗支出面板调查，我们确定了每种访问类型的平均每次访问支付。使用全国医院门诊医疗服务调查和全国范围内的住院病人样本，我们估计总支出和NHE按访问category.Results的比例成本：急诊科发作的护理占328.1亿美元的支付在2010年。这占NHE的12.5%;艾德入院率为8.3%，门诊艾德护理为4.2%。非急诊门诊就诊是最常见的，占艾德发作的30.4%，非ACSC入院费用最高，为1883亿美元。潜在可避免的遭遇占644亿美元，19.6%的艾德发作，和2.4%的NHE.Conclusions：超过1在10医疗保健美元花费在艾德发作的护理。其中，只有不到五分之一的费用是可以避免的;因此，通过改善初级保健来减少艾德就诊的努力可能对总体成本影响不大。(C)2015爱思唯尔公司All rights reserved.
Background: Emergency department (ED) care is a focus of cost reduction efforts. Costs for acute care originating in the ED, including outpatient and inpatient encounters (i.e. ED episodes), have not been estimated.Objective: We estimate total US costs of ED episodes, potentially avoidable costs, and proportional costs of national health expenditures (NHEs).Methods: We conducted a secondary analysis of 2010 data from the Medical Expenditure Panel Survey, National Hospital Ambulatory Medical Care Survey, and the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Outpatient ED encounters were categorized based on the New York University algorithm and admissions by ambulatory care-sensitive condition (ACSC) vs non-ACSC. Potentially avoidable encounters were nonemergent ED visits and ACSC hospital admissions. Using the Medical Expenditure Panel Survey, we determined mean per-visit payments for each visit type. Using the National Hospital Ambulatory Medical Care Survey and Nationwide Inpatient Sample, we estimated aggregate expenditures and proportional costs of NHE by visit category.Results: Emergency department episodes of care accounted for $328.1 billion in payments in 2010. This represented 12.5% of NHE; ED admissions were 8.3% and outpatient ED care was 4.2%. Nonemergent outpatient visits were the most common, comprising 30.4% of ED episodes, and non-ACSC admissions were the most costly at $188.3 billion. Potentially avoidable encounters accounted for $64.4 billion, 19.6% of ED episodes, and 2.4% of NHE.Conclusions: More than 1 in 10 health care dollars is spent on ED episodes of care. Of this, less than 1 in 5 dollars is potentially avoidable; therefore, efforts to reduce ED visits through improved primary care may have little impact on overall costs. (C) 2015 Elsevier Inc. All rights reserved.