Drivers of Increasing Emergency Ambulance Demand
Drivers of Increasing Emergency Ambulance Demand
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DOI：
10.1080/10903127.2019.1635670
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发表时间：
2019-08-01
影响因子：
2.4
通讯作者：
Smith, Karen
中科院分区：
文献类型：
--
作者：
Andrew, Emily;Nehme, Ziad;Smith, Karen
目的：虽然驱动急诊部门需求的因素已被广泛调查，一个相对较小的量是已知的驱动因素，在紧急救护车的需求增加。研究方法：我们对2008年至2015年在澳大利亚墨尔本由救护车维多利亚救护的连续病例进行了回顾性观察研究。计算发病率，并进行调整后的时间序列回归分析，以评估救护车需求的驱动因素。结果：共纳入2，443，952例连续病例。需求在8年期间增长了29.2%。年龄< 60岁的患者的年龄特异性发病率随时间显著增加，但年龄>= 60岁的患者则无此现象。经季节性和人口增长调整后，需求每年增长1.4%（事故率[IRR] = 1.014 [1.011-1.017]）。在有心理健康问题史（IRR = 1.058 [1.054-1.062]）、酒精/药物滥用史（IRR = 1.061 [1.056-1.066]）或Charlson合并症指数[CCI]评分>= 4（IRR = 1.045 [1.039-1.051]）的患者中观察到需求的最大年度增长。根据CCI，涉及相对社会经济/教育不利、年龄较小或没有预先存在的健康状况的患者的病例也比总体患者人群增长得更快。需要转运到医院的病例每年增加1.2%（IRR = 1.012 [1.009-1.016]），尽管不需要护理人员医疗干预的患者每年增加6.7%（IRR = 1.067 [1.063-1.072]）。结论：救护车需求的增长超过了人口增长。紧急救护车越来越多地用于运送不需要护理人员进行医疗干预的病人。识别患者驾驶救护车需求的特点将使有针对性的需求管理策略。
Objectives: Although the factors driving emergency department demand have been extensively investigated, a comparatively minimal amount is known about the factors that are driving an increase in emergency ambulance demand. Methods: We conducted a retrospective observational study of consecutive cases attended by Ambulance Victoria in Melbourne, Australia from 2008 to 2015. Incidence rates were calculated, and adjusted time series regression analyses were performed to assess the driving factors of ambulance demand. Results: A total of 2,443,952 consecutive cases were included. Demand grew by 29.2% over the 8-year period. The age-specific incidence increased significantly over time for patients aged < 60 years, but not for patients aged >= 60 years. After adjustment for seasonality and population growth, demand increased by 1.4% per annum (incident rate ratio [IRR] = 1.014 [1.011-1.017]). The largest annual growth in demand was observed in patients with a history of mental health issues (IRR = 1.058 [1.054-1.062]), alcohol/drug abuse (IRR = 1.061 [1.056-1.066]), or a Charlson Comorbidity Index [CCI] score >= 4 (IRR = 1.045 [1.039-1.051]). Cases involving patients of relative socio-economic/educational disadvantage, younger age, or with no preexisting health conditions according to the CCI also grew faster than the overall patient population. Cases requiring transport to hospital increased by 1.2% annually (IRR = 1.012 [1.009-1.016]), although patients not requiring medical intervention from paramedics increased by 6.7% annually (IRR = 1.067 [1.063-1.072]). Conclusions: Increases in ambulance demand exceeded population growth. Emergency ambulances were increasingly utilized for transport of patients who did not require medical intervention from paramedics. Identifying the characteristics of patients driving ambulance demand will enable targeted demand management strategies.