Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits
Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits
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DOI：
10.1200/jop.18.00743
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发表时间：
2019-06-01
影响因子：
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通讯作者：
Halm, Ethan A.
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文献类型：
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作者：
Hong, Arthur S.;Froehlich, Thomas;Halm, Ethan A.
目的：专门为癌症患者设立的紧急护理诊所是否会影响新诊断为癌症的成年人的急诊就诊？患者和方法：我们对2009年至2016年期间在综合癌症中心诊断为癌症的18岁或以上成年人进行的调整后的每月急诊科就诊进行了中断时间序列分析。癌症登记患者与急诊科和医院就诊的纵向区域数据库相关联。由于紧急护理诊所在周末关闭，我们利用自然实验的优势，将周末的访问作为对照组进行比较。我们的主要结果是癌症诊断后180天内的急诊就诊率，编辑为每1,000患者月的急诊就诊率。结果：2012年5月之前，工作日急诊科就诊率以每月0.43次（95%CI，0.29至0.57次）的速度增加，然后在紧急护理诊所成立后下降一半，每月0.19次（95%CI，0.11至0.28次）（P = 0.007）。相比之下，2012年5月之前的周末访视率以每月0.08次（95% CI，-0.03至0.19次访视）的速度增长，之后为0.05次（95% CI，-0.02至0.13次访视; P = 0.533）。截至2016年底，每月工作日急诊就诊次数比预期少15.3次（P = 0.005）。在平日住院的趋势没有显着changed.CONCLUSION：虽然只有八分之一的急诊科就诊的患者也使用紧急护理诊所，急诊科就诊的增长率下降了一半后，紧急护理诊所成立。
PURPOSE:Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer?PATIENTS AND METHODS:We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome.RESULTS:The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month (P = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, -0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, -0.02 to 0.13 visits; P = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected (P = .005). Trends in weekday hospitalizations were not significantly changed.CONCLUSION:Although only one in eight emergency department-visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.