Can the emergency department algorithm detect changes in access to care?
Can the emergency department algorithm detect changes in access to care?
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DOI：
10.1111/j.1553-2712.2008.00108.x
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发表时间：
2008-06-01
影响因子：
4.4
通讯作者：
Fu, Rongwei
中科院分区：
文献类型：
--
作者：
Lowe, Robert A.;Fu, Rongwei
目的：“急诊科算法”（EDA）使用急诊科（艾德）诊断来分配就诊福尔斯四类的概率：非急诊、初级护理可治疗的急诊、需要艾德护理的可预防急诊和不可预防急诊。EDA的开发人员报告说，它可以评估医疗安全网，因为获得护理机会较差的患者将在不太紧急的情况下使用ED。后俄勒冈州健康计划（OHP，俄勒冈州的扩大医疗补助计划）在2003年进行了削减影响获得护理，作者测试了EDA检测艾德use.Methods的变化的能力：所有访问22俄勒冈州ED在2002年期间进行了比较访问在2004年。对于每个付款人类别，平均概率，艾德访问属于四个类别中的每一个进行了比较之前与之后的OHP cutbacks.Results：平均概率的最大变化后削减为2%。试图通过其他分析策略来提高EDA的灵敏度，但没有成功。相比之下，艾德就诊人数从2002年的6,682/月增加到2004年的9,058/月，导致住院的无保险就诊人数比例增加了51%。结论：与其他简单的措施相比，EDA在显示医疗服务获得变化方面的作用较小。EDA的方法论问题，可能会占这种限制进行了讨论。鉴于EDA在卫生政策研究人员中的广泛采用，作者得出结论，需要进一步完善该方法。
Objectives: The "emergency department algorithm" (EDA) uses emergency department (ED) diagnoses to assign probabilities that a visit falls into each of four categories: nonemergency, primary care-treatable emergency, preventable emergency needing ED care, and nonpreventable emergency. The EDA's developers report that it can evaluate the medical safety net because patients with worse access to care will use EDs for less urgent conditions. After the Oregon Health Plan (OHP, Oregon's expanded Medicaid program) underwent cutbacks affecting access to care in 2003, the authors tested the ability of the EDA to detect changes in ED use.Methods: All visits to 22 Oregon EDs during 2002 were compared with visits during 2004. For each payer category, mean probabilities that ED visits fell into each of the four categories were compared before versus after the OHP cutbacks.Results: The largest change in mean probabilities after the cutbacks was 2%. Attempts to enhance the sensitivity of the EDA through other analytic strategies were unsuccessful. By contrast, ED visits by the uninsured increased from 6,682/month in 2002 to 9,058/month in 2004, and the proportion of uninsured visits leading to hospital admission increased by 51%.Conclusions: The EDA was less useful in demonstrating changes in access to care than were other, simpler measures. Methodologic concerns with the EDA that may account for this limitation are discussed. Given the widespread adoption of the EDA among health policy researchers, the authors conclude that further refinement of the methodology is needed.