After-Hours Care in Suburban Canada: Influencing Emergency Department Utilization
After-Hours Care in Suburban Canada: Influencing Emergency Department Utilization
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DOI：
10.1177/2150131911408431
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发表时间：
2011-10-01
影响因子：
3.6
通讯作者：
Frank, Leonard
中科院分区：
文献类型：
--
作者：
Jones, David;Carroll, Linda;Frank, Leonard
目的：确定门诊“下班后”诊所（AHC）的运营是否与当地急诊科（艾德）就诊减少相关。研究环境：加拿大阿尔伯塔省勒杜克是一座拥有约20，000人口的城市。有一个医院艾德和一个AHC。从2005年1月至2008年2月收集了关于AHC和艾德访视的信息。研究设计：这是一项每月艾德访视频率的观察性前后研究，按患者疾病严重程度分层。数据收集：我们收集了AHC实施前后每月到艾德就诊的患者。收集了28个月的艾德患者访视信息（AHC前14个月; AHC后14个月）。使用Wilcoxon符号秩检验检验AHC开始运行前后按月匹配的艾德访视差异的统计学强度。结果：平均每月有261.2（标准差[SD]，47.7）例患者访问AHC。在AHC工作时间内，每月到Leduc艾德就诊的患者总数平均减少了36.7（平均值的标准误差[SEM]，9.6; P = 0.009），每月到Leduc的半紧急患者就诊减少了49.3（SEM，5.6; P = 0.001）。结论：在AHC手术后，到艾德就诊的患者总数持续观察到统计学显著减少。分层分析表明，这是由于在当地急诊室寻求医疗服务的半紧急患者减少。
Objective: To determine if operation of an outpatient "after-hours" clinic (AHC) was associated with a reduction in local emergency department (ED) visits. Study Setting: Leduc, Alberta, Canada is a city of approximately 20 000 people. There is one hospital ED and a single AHC. Information on AHC and ED visits was collected from January 2005 to February 2008. Study Design: This was an observational before-and-after study of monthly ED visit frequency, stratified by patient illness severity. Data Collection: We collected patient visits per month to the ED before and after AHC implementation. Twenty-eight months of ED patient visit information were collected (14 months of pre-AHC; 14 months of post-AHC). A Wilcoxon signed-rank test was used to test the statistical strength of difference in ED visits, matched by month, before and after the AHC became operational. Results: An average of 261.2 (standard deviation [SD], 47.7) patient visits per month were made to the AHC. There was a mean reduction of 36.7 (standard error of mean [SEM], 9.6; P = .009) total patient visits per month and 49.3 (SEM, 5.6; P = .001) fewer semiurgent patient visits per month to the Leduc ED during AHC operating hours. Conclusions: There was a consistently observable and statistically significant reduction in total patients visiting the ED subsequent to AHC operation. Stratified analysis indicated that this was due to fewer semiurgent patients seeking medical care at the local ED.