Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease - Can we meet the requirements of an aging population?
Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease - Can we meet the requirements of an aging population?
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DOI：
10.1001/jama.284.21.2762
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发表时间：
2000-12-06
影响因子：
120.7
通讯作者：
Popovich, J
中科院分区：
文献类型：
--
作者：
Angus, DC;Kelley, MA;Popovich, J
背景医学的两个重要领域，危重病人的护理和肺部疾病的管理，可能会受到美国人口老龄化的影响。目的估计美国成人重症监护和肺部医学医生的当前和未来需求。设计，设置和参与者分析现有的人口，患者和医院数据集和前瞻性，重症监护室（ICU）主任（n=393）和重症监护专家的全国代表性调查（重症监护医生）和肺科专家（肺科医师）（n=421），从1996年至1999年进行。主要结果测量患者、医生、地区、医院和付款人的特点，目前的做法模式;预测未来的供应和需求的专科护理，到2030年。重症监护和肺部疾病的单独模型。基本情况预测与敏感性分析，以估计未来的变化，在培训和退休，疾病的患病率和管理，和卫生保健改革initiatives.Results的影响，在1997年，重症监护提供照顾的36.8%的所有ICU病人，在ICU护理提供更普遍的重症监护在高管理医疗渗透率的地区，预计目前的供求比例在2007年之前将保持大致平衡，随后，需求将迅速增长，而供应将保持接近稳定，到2020年，专家小时的短缺相当于需求的22%，到2030年为35%，主要是因为美国人口的老龄化。敏感性分析表明，当前医疗改革举措的推广要么没有效果，要么会加剧这一缺口。在2007年之前，肺科医生的时间也将短缺，到2020年将增加到35%，到2030年将增加到46%。结论我们预测，在美国，重症监护医生和肺科医生提供的护理比例将在不到10年的时间内下降到低于目前的标准。虽然目前的医疗保健改革举措和修改现有的实践模式可能会暂时阻止这个问题，大多数预期的影响相比，美国人口老龄化所造成的日益严重的疾病负担是轻微的。
Context Two important areas of medicine, care of the critically ill and management of pulmonary disease, are likely to be influenced by the aging of the US population.Objective To estimate current and future requirements for adult critical care and pulmonary medicine physicians in the United States.Design, Setting, and Participants Analysis of existing population, patient, and hospital data sets and prospective, nationally representative surveys of intensive care unit (ICU) directors (n=393) and critical care specialists (intensivists) and pulmonary specialists (pulmonologists) (n=421), conducted from 1996 to 1999.Main Outcome Measures Influence of patient, physician, regional, hospital, and payer characteristics on current practice patterns; forecasted future supply of and demand for specialist care through 2030. Separate models for critical care and pulmonary disease. Base-case projections with sensitivity analyses to estimate the impact of future changes in training and retirement, disease prevalence and management, and health care reform initiatives.Results In 1997, intensivists provided care to 36.8% of all ICU patients, Care in the ICU was provided more commonly by intensivists in regions with high managed care penetration, The current ratio of supply to demand is forecast to remain in rough equilibrium until 2007, Subsequently, demand will grow rapidly while supply will remain near constant, yielding a shortfall of specialist hours equal to 22% of demand by 2020 and 35% by 2030, primarily because of the aging of the US population. Sensitivity analyses suggest that the spread of current health care reform initiatives will either have no effect or worsen this shortfall. A shortfall of pulmonologist time will also occur before 2007 and increase to 35% by 2020 and 46% by 2030,Conclusions We forecast that the proportion of care provided by intensivists and pulmonologists in the United States will decrease below current standards in less than 10 years. While current health care reform initiatives and modification of existing practice patterns may temporarily forestall this problem, most anticipated effects are minor in comparison with the growing disease burden created by the aging US population.