Reducing Variation In Hospital Admissions From The Emergency Department For Low-Mortality Conditions May Produce Savings
Reducing Variation In Hospital Admissions From The Emergency Department For Low-Mortality Conditions May Produce Savings
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DOI：
10.1377/hlthaff.2013.1318
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发表时间：
2014-09-01
期刊：
影响因子：
9.7
通讯作者：
Kocher, Keith E.
中科院分区：
文献类型：
--
作者：
Sabbatini, Amber K.;Nallamothu, Brahmajee K.;Kocher, Keith E.
急诊科（艾德）现在是美国住院的主要来源，急诊科之间所有原因的入院率差异很大。在这项研究中，我们使用了一个全国性的艾德就诊样本，以检查风险标准化的急诊入院率的变化，以及这种变化与15种最常见的内科和外科疾病的住院死亡率的关系。然后，我们估计的影响，在不同的利用情况下，国家卫生支出的变化。急诊科的风险标准化入院率差异很大，在第25次和第75次随访之间，败血症的入院率为1.03倍，胸痛的入院率为6.55倍。胸痛、软组织感染、哮喘、慢性阻塞性肺病和尿路感染等疾病是死亡率较低的疾病，但变化最大。这表明，其中一些入院可能是不必要的，因此代表着提高效率和减少卫生支出的机会。我们的数据表明，如果艾德住院实践的差异可以在这些高变异、低死亡率的条件中缩小，美国支付者可能会节省相当大的费用。
The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions.