Short-term Outcomes for Medicare Beneficiaries After Low-acuity Visits to Emergency Departments and Clinics.
Short-term Outcomes for Medicare Beneficiaries After Low-acuity Visits to Emergency Departments and Clinics.
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医疗保险受益人在急诊室和诊所进行低度就诊后的短期结果。
DOI：
10.1097/mlr.0000000000000513
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发表时间：
2016
期刊：
影响因子：
3
通讯作者：
Obermeyer,Ziad
中科院分区：
文献类型：
--
作者：
Niedzwiecki,Matthew;Baicker,Katherine;Wilson,Michael;Cutler,DavidM;Obermeyer,Ziad
背景：有很大的兴趣，以确定低敏度访问急诊科（ED），可以更适当地在其他设置。艾德患者和其他地方的可比患者之间疾病严重程度的系统性差异可能使这种策略不安全，但几乎没有证据可以指导政策制定者。目的：通过比较短期死亡率和住院率，控制患者人口统计学，合并症和就诊急性期，比较急诊和门诊患者之间的疾病严重程度。研究设计：医疗接触后结果的横断面研究。受试者：2011年从艾德或诊所就诊出院的医疗保险按服务收费受益人的全国代表性20%样本，测量：从艾德或门诊就诊出院回家后8、15和30天的全因死亡率和住院率。结果：在对患者人口统计学、合并症、残疾和双重资格状态以及常用算法测量的就诊敏锐度进行风险调整后，我们发现艾德患者更容易死亡（风险调整比值比= 2.75; 95%可信区间，2.56-2.96）或出院后住院（比值比= 1.97; 95%可信区间，1.95-2.00）。短期结果的差异，观察，即使当比较相同的出院诊断后risk adjustment.Conclusions：急诊科的患者有更差的风险调整后的短期结果比那些提出门诊，即使在控制了急性水平的访问或出院诊断。现有的措施，使用行政数据的敏锐度可能无法充分捕捉疾病的严重程度，判断适当的设置护理困难。
Background:There is substantial interest in identifying low-acuity visits to emergency departments (EDs) that could be treated more appropriately in other settings. Systematic differences in illness severity between ED patients and comparable patients elsewhere could make such strategies unsafe, but little evidence exists to guide policy makers.Objective:To compare illness severity between patients visiting EDs and outpatient clinics, by comparing short-term mortality and hospitalization, controlling for patient demographics, comorbidity, and visit acuity.Research Design:Cross-sectional study of outcomes after medical encounters.Subjects:Nationally representative 20% sample of Medicare fee-for-service beneficiaries discharged home from ED or clinic visit in 2011, and enrolled continuously for 1 year before the visit.Measures:All-cause mortality and hospitalization in the 8, 15, and 30 days after discharge home from ED or clinic visits.Results:After risk-adjusting for patient demographic, comorbidity, disability, and dual-eligibility status, as well as visit acuity as measured by a commonly used algorithm, we found that ED patients were more likely to die (risk-adjusted odds ratio= 2.75; 95% confidence interval, 2.56–2.96) or be hospitalized (odds ratio= 1.97; 95% confidence interval, 1.95–2.00) after discharge than clinic patients. Differences in short-term outcomes were observed even when comparing patients with the same discharge diagnoses after risk adjustment.Conclusions:Patients presenting to EDs have worse risk-adjusted short-term outcomes than those presenting to outpatient clinics, even after controlling for acuity level of visit or discharge diagnosis. Existing measures of acuity using administrative data may not adequately capture severity of illness, making judgments of the appropriate setting for care difficult.