Measures of ED Utilization in a National Cohort of Children
Measures of ED Utilization in a National Cohort of Children
复制标题
DOI：
10.37765/ajmc.2020.43490
复制
发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Auger, Katherine A.
中科院分区：
文献类型：
--
作者：
Andrews, Annie Lintzenich;Bettenhausen, Jessica;Auger, Katherine A.
注意事项：急诊科（艾德）利用率通常被用作慢性病控制不良和/或护理质量差的指标。我们试图确定是否2艾德利用措施识别临床或人口统计学上不同的人群childhes.Study设计：回顾性队列研究利用IBM健康/Truven MarketScan Medicaid data.METHODS：儿童和青少年进行了分类的基础上的存在和复杂性的慢性疾病使用3 M临床风险组系统。儿童和青少年被归类为高艾德利用者，使用2个指标：（1）艾德依赖（EDR）（艾德就诊次数/ [艾德就诊次数+门诊就诊次数]; EDR >0.33 =高利用者）和（2）就诊次数（≥ 3次艾德就诊=高利用者）。Logistic回归模型确定了与我们的每一个结果measurements.Results相关的患者因素：共有5，438，541名儿童和青少年被纳入; 65%没有慢性疾病（WO-CD），32%有非复杂性慢性疾病（NC-CD），3%有复杂性慢性疾病（C-CD）。EDR确定18%为频繁使用者，而访问计数测量为7%。在访问计数模型中，年龄小于2岁的儿童以及被归类为WO-CD和NC-CD的儿童不太可能被确定为高利用者。相反，在EDR模型中，2岁及以上的儿童和青少年以及那些被归类为WO-CD和NC-CD的人更有可能被归类为高utilizers.CONCLUSIONS：艾德利用措施确定临床和人口统计学上不同的患者群体。未来的研究应考虑正在研究的人口的医学复杂性，然后再选择最合适的措施。
OBJECTIVES: Emergency department (ED) utilization is often used as an indicator of poor chronic disease control and/or poor quality of care. We sought to determine if 2 ED utilization measures identify clinically or demographically different populations of children.STUDY DESIGN: Retrospective cohort study utilizing IBM Health/Truven MarketScan Medicaid data.METHODS: Children and adolescents were categorized based on the presence and complexity of chronic medical conditions using the 3M Clinical Risk Group system. Children and adolescents were categorized as high ED utilizers using 2 measures: (1) ED reliance (EDR) (number of ED visits/ [number of ED visits+ number of ambulatory visits]; EDR >0.33 = high utilizer) and (2) visit counts (>= 3 ED visits= high utilizer). Logistic regression models identified patient factors associated with each of our outcome measures.RESULTS: A total of 5,438,541 children and adolescents were included; 65% were without chronic disease (WO-CD), 32% had noncomplex chronic disease (NC-CD), and 3% had complex chronic disease (C-CD). EDR identified 18% as frequent utilizers compared with 7% by the visit count measure. In the visit count model, children younger than 2 years and those classified as WO-CD and NC-CD were less likely to be identified as high utilizers. Conversely, in the EDR model children and adolescents 2 years and older and those classified as WO-CD and NC-CD were more likely to be classified as high utilizers.CONCLUSIONS: The ED utilization measures identify clinically and demographically different groups of patients. Future studies should consider the medical complexity of the population being studied before choosing the most appropriate measure to employ.