Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.
Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.
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急诊室的快速初级保健随访，以减少可避免的住院入院。
DOI：
10.5811/westjem.2017.5.33593
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Tung J
中科院分区：
文献类型：
--
作者：
Carmel AS;Steel P;Tanouye R;Novikov A;Clark S;Sinha S;Tung J
急诊科（艾德）的入院人数现在约占所有入院人数的50%。如果门诊护理可以得到优化，从艾德收治的一些患者可能不需要住院护理。然而，获得初级保健，特别是在艾德出院后立即获得初级保健是具有挑战性的。研究还没有解决从艾德住院可以避免快速（下一个工作日）的初级保健随访的程度。我们评估了ED到快速初级保健协议对避免大型城市医疗中心住院的影响。我们对通过纽约长老会/威尔康奈尔医学中心开发的快速获得初级保健计划从艾德转诊到初级保健（威尔康奈尔内科协会- WCIMA）的患者进行了回顾性分析。转诊分为避免入院或不避免入院，并由急诊医生（EP）和内科医生评审员进行分类。我们还收集了关于快速访视完成、艾德复诊、住院和初级保健参与的结局数据。EP将26例（16%）转诊进行快速初级保健随访的病例归类为避免入院。在162名转诊接受快速随访的患者中，有118名（73%）接受了快速预约。参加快速随访的患者和未参加的患者之间的艾德复诊率或随后的住院率没有差异。参加快速预约的患者在索引艾德访视后6个月内参加至少一次WCIMA后续预约的可能性显著更高[N=55（47%）vs. N=8（18%），P=0.001]。一个快速艾德到初级保健访问程序可以允许EP避免承认病人到医院，而不会冒着艾德复诊或随后住院的风险。随着时间的推移，该协议有可能节省成本。像这样的计划也可以提供一个安全可靠的艾德出院选择，这也是一个有效的机制，让患者参与初级保健。
Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates – WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option that is also an effective mechanism for engaging patients in primary care.
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影响因子：
120.7
作者：
Asplin, BR;Rhodes, KV;Kellermann, AL
通讯作者：
Kellermann, AL
影响因子：
6.2
作者：
Doran, Kelly M.;Colucci, Ashley C.;Wall, Stephen P.
通讯作者：
Wall, Stephen P.
影响因子：
3.6
作者：
Elliott, Kailyn;Klein, Jared W.;Sabbatini, Amber K.
通讯作者：
Sabbatini, Amber K.
影响因子：
6.2
作者：
Smulowitz, Peter B.;Honigman, Leah;Landon, Bruce E.
通讯作者：
Landon, Bruce E.
影响因子：
1.4
作者：
Blanchard, Janice;Ogle, Kathleen;Lurie, Nicole
通讯作者：
Lurie, Nicole