Comparison of Emergency Care Delivered to Children and Young Adults With Complex Chronic Conditions Between Pediatric and General Emergency Departments
Comparison of Emergency Care Delivered to Children and Young Adults With Complex Chronic Conditions Between Pediatric and General Emergency Departments
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DOI：
10.1111/acem.12412
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发表时间：
2014-07-01
影响因子：
4.4
通讯作者：
Grupp-Phelan, Jacqueline M.
中科院分区：
文献类型：
--
作者：
Kurowski, Eileen Murtagh;Byczkowski, Terri;Grupp-Phelan, Jacqueline M.
目标：越来越多地关注医疗复杂的儿童和青年，例如患有复杂慢性病的儿童和青年，因为他们是住院天数和资源的高消费群体。然而，对于这些患有复杂慢性疾病的儿童和年轻人在哪里寻求急诊治疗，以及急诊部门（ED）的类型是否影响入院的可能性，人们知之甚少。作者试图在全国范围内估计患有复杂慢性疾病的儿童和年轻人使用ED的情况，并评估过渡到成人护理的年龄是否显著影响护理地点和住院的可能性。方法：这是一项横断面研究，使用2008年全国急诊科样本（NEDS）、医疗成本和利用项目（HCUP）、医疗保健研究和质量机构的出院数据，评估儿科年龄患者（17岁或以下）和过渡年龄患者（18至24岁）就诊儿科或普通急诊科，至少有一种复杂慢性疾病。主要结局指标为住院率、治疗出院就诊的急诊科收费和住院患者的总收费。结果：2008年，69%的儿科老年患者和92%的过渡老年患者就诊于综合急诊科。毫不奇怪，儿童年龄是儿童急诊科就诊的最强预测因子（优势比[OR] = 15.86； 95%可信区间[CI] = 12.3至20.5）。技术依赖（OR = 1.56; 95% CI = 1.2至2.0）和多种复杂慢性疾病的存在（OR = 1.39; 95% CI = 1.2至1.6）也与儿科急诊科就诊的较高几率相关。在控制患者和医院特征后，急诊科类型并不是两年龄组住院（p = 0.87）或总费用（p = 0.26）的显著预测因子。结论：总体而言，本研究表明，尽管其复杂性，绝大多数患有多种复杂慢性疾病的儿童和年轻人在普通急诊科接受治疗。在控制患者和医院特征的情况下，儿科急诊科和普通急诊科住院患者的住院率和总收费没有差异。这一结果强调了对这些医学复杂的儿童和年轻人在儿科专业中心之外接受的护理的更多关注的必要性。这些结果还强调，未来任何用于评估患有复杂慢性疾病的儿童和年轻人急诊护理质量的绩效指标都必须适用于儿科和普通急诊科。(C) 2014年由学术急诊医学学会出版
Objectives: Increasing attention is being paid to medically complex children and young adults, such as those with complex chronic conditions, because they are high consumers of inpatient hospital days and resources. However, little is known about where these children and young adults with complex chronic conditions seek emergency care and if the type of emergency department (ED) influences the likelihood of admission. The authors sought to generate nationwide estimates for ED use by children and young adults with complex chronic conditions and to evaluate if being of the age for transition to adult care significantly affects the site of care and likelihood of hospital admission.Methods: This was a cross-sectional study using discharge data from the 2008 Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality to evaluate visits to either pediatric or general EDs by pediatric-aged patients (17 years old or younger) and transition-aged patients (18 to 24 years old) with at least one complex chronic condition. The main outcome measures were hospital admission, ED charges for treat-and-release visits, and total charges for admitted patients.Results: In 2008, 69% of visits by pediatric-aged and 92% of visits by transition-aged patients with multiple complex chronic conditions occurred in general EDs. Not surprisingly, pediatric age was the strongest predictor of seeking care in a pediatric ED (odds ratio [OR] = 15.86; 95% confidence interval [CI] = 12.3 to 20.5). Technology dependence (OR = 1.56; 95% CI = 1.2 to 2.0) and presence of multiple complex chronic conditions (OR = 1.39; 95% CI = 1.2 to 1.6) were also associated with higher odds of seeking care in a pediatric ED. When controlling for patient and hospital characteristics, type of ED was not a significant predictor of admission (p = 0.87) or total charges (p = 0.26) in either age group.Conclusions: Overall, this study shows that, despite their complexity, the vast majority of children and young adults with multiple complex chronic conditions are cared for in general EDs. When controlling for patient and hospital characteristics, the admission rate and total charges for hospitalized patients did not differ between pediatric and general EDs. This result highlights the need for increased attention to the care that these medically complex children and young adults receive outside of pediatric-specialty centers. These results also emphasize that any future performance metrics developed to evaluate the quality of emergency care for children and young adults with complex chronic conditions must be applicable to both pediatric and general ED settings. (C) 2014 by the Society for Academic Emergency Medicine