Frequent users of emergency department services: gaps in knowledge and a proposed research agenda.
Frequent users of emergency department services: gaps in knowledge and a proposed research agenda.
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DOI：
10.1111/j.1553-2712.2011.01086.x
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发表时间：
2011-06-01
期刊：
影响因子：
--
通讯作者：
Yealy, Donald M
中科院分区：
文献类型：
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作者：
Pines, Jesse M;Asplin, Brent R;Yealy, Donald M
经常使用急诊科（ED）服务通常被认为是一种潜在的可预防的资源滥用。潜在的假设是，类似的和更合适的护理可以在急诊室以外以更低的成本提供。为了降低成本和鼓励更适当地使用服务，已经努力设计干预措施，将经常使用者的医疗保健利用从急诊科转移到其他环境，如门诊诊所。许多这些努力在小规模试验中取得了成功，但由于各种原因，更广泛的应用仍然难以实现。假设所有甚至大部分频繁使用ED的人都是误用，并提出过度使用ED的原因，也存在一些根本问题。当将频繁用户作为一个群体与不那么频繁的用户进行比较时，这些脆弱的假设就变得显而易见了。具体来说，频繁使用者倾向于频繁使用ED，疾病严重程度较高，年龄较大，个人资源较少，患有慢性疾病，患有与疼痛相关的疾病，并且有政府保险（医疗保险或医疗补助）。由于频繁使用ED人群的独特特征，我们提出了一项研究议程，旨在通过以下方式增加对频繁使用ED的理解：1)为频繁使用者创建一个公认的分类系统，2)预测哪些患者有成为或保持频繁使用者的风险，3)实施基于ED和非ED的干预措施，以及4)对频繁ED使用者进行定性研究，以探索原因和确定需要干预的因素，并根据疾病（如精神疾病和心力衰竭）探索人群之间的具体差异。
Frequent use of emergency department (ED) services is often perceived to be a potentially preventable misuse of resources. The underlying assumption is that similar and more appropriate care can be delivered outside of EDs at a lower cost. To reduce costs and incentivize more appropriate use of services, there have been efforts to design interventions to transition health care utilization of frequent users from EDs to other settings such as outpatient clinics. Many of these efforts have succeeded in smaller trials, but wider use remains elusive for varying reasons. There are also some fundamental problems with the assumption that all or even the majority of frequent ED use is misuse and invoking reasons for that excessive use. These tenuous assumptions become evident when frequent users as a group are compared to less frequent users. Specifically, frequent users tend to have high levels of frequent ED use, have a higher severity of illness, be older, have fewer personal resources, be chronically ill, present for pain-related complaints, and have government insurance (Medicare or Medicaid). Because of the unique characteristics of the population of frequent users, we propose a research agenda that aims to increase the understanding of frequent ED use, by: 1) creating an accepted categorization system for frequent users, 2) predicting which patients are at risk for becoming or remaining frequent users, 3) implementing both ED- and non-ED-based interventions, and 4) conducting qualitative studies of frequent ED users to explore reasons and identify factors that are subject to intervention and explore specific differences among populations by condition, such as mental illness and heart failure.