An Intervention Connecting Low-Acuity Emergency Department Patients With Primary Care: Effect on Future Primary Care Linkage
An Intervention Connecting Low-Acuity Emergency Department Patients With Primary Care: Effect on Future Primary Care Linkage
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DOI：
10.1016/j.annemergmed.2012.10.021
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发表时间：
2013-03-01
影响因子：
6.2
通讯作者：
Wall, Stephen P.
中科院分区：
文献类型：
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作者：
Doran, Kelly M.;Colucci, Ashley C.;Wall, Stephen P.
研究目标：我们的目标是确定将有意愿的低视力患者从急诊科(ED)引导到初级保健诊所的护理点干预是否会增加未来的初级保健随访。方法：我们在一家城市安全网医院进行了一项准实验性试验。向ED提出特定低视力问题的成年人是有资格的。如果患者由急救医疗服务到达，如果发烧，或者如果分诊护士认为他们需要急诊护理，则排除在外。我们招募了965名患者。导航员护送一部分自愿参与者到初级保健诊所(在同一医院建筑群中)，在那里他们被分配了一名私人医生，获得了诊所服务的概述，并接受了当天的诊所护理。结果：在双变量意向治疗分析中，50.3%的干预组患者和36.9%的对照组患者在干预后的一年内至少有一次初级保健诊所的随访。在多变量分析中，与对照组相比，干预组至少有一次初级保健诊所随访的绝对差异为9.3%(95%可信区间为2.2%至16.3%)。未来急诊室就诊的次数没有显著差异。结论：与标准的急诊室转诊做法相比，为低视力的急诊室患者提供在医院初级保健诊所接受替代治疗的机会的点护理干预措施导致了未来初级保健随访的增加。访问数/每百万人：Reach for[Ann Emerg2013；61：312-321。]
Study objective: Our objective is to determine whether a point-of-care intervention that navigates willing, low-acuity patients from the emergency department (ED) to a Primary Care Clinic will increase future primary care follow-up.Methods: We conducted a quasi-experimental trial at an urban safety net hospital. Adults presenting to the ED for select low-acuity problems were eligible. Patients were excluded if arriving by emergency medical services, if febrile, or if the triage nurse believed they required ED care. We enrolled 965 patients. Navigators escorted a subset of willing participants to the Primary Care Clinic (in the same hospital complex), where they were assigned a personal physician, were given an overview of clinic services, and received same-day clinic care. The primary outcome was Primary Care Clinic follow-up within 1 year of the index ED visit among patients having no previous primary care provider.Results: In the bivariate intention-to-treat analysis, 50.3% of intervention group patients versus 36.9% of control group patients with no previous primary care provider had at least 1 Primary Care Clinic follow-up visit in the year after the intervention. In the multivariable analysis, the absolute difference in having at least 1 Primary Care Clinic follow-up for the intervention group compared with the control group was 9.3% (95% confidence interval 2.2% to 16.3%). There was no significant difference in the number of future ED visits.Conclusion: A point-of-care intervention offering low-acuity ED patients the opportunity to alternatively be treated at the hospital's Primary Care Clinic resulted in increased future primary care follow-up compared with standard ED referral practices. [Ann Emerg Med. 2013;61:312-321.]