Enhancing systems to improve the management of acute, unscheduled care.
Enhancing systems to improve the management of acute, unscheduled care.
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DOI：
10.1111/j.1553-2712.2011.01080.x
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发表时间：
2011-06-01
期刊：
影响因子：
--
通讯作者：
Epstein, Stephen K
中科院分区：
文献类型：
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作者：
Braithwaite, Sabina A;Pines, Jesse M;Epstein, Stephen K
对于急症患者，可以在许多不同的环境中获得医疗保健服务，包括医院急诊科（ed）、零售诊所、联邦合格的医疗中心和门诊诊所。某些情况是特定环境的唯一领域：危重病人的稳定通常只能在急诊科提供。相比之下，许多不需要医院资源的情况，如高级放射照相、入院和当日会诊，通常可以在诊所进行管理。因为诊所一般晚上不开放，而且通常周末或节假日也不开放，所以在这些时间里，急诊室仍然是面对面医疗护理的唯一选择。对于可以在任何一种环境中进行治疗的患者，关于哪一种环境是最好的，有许多悬而未决的研究问题，因为这些场所在获取、护理成本和潜在的质量方面都有所不同。对这些患者的考虑必须进行风险调整，因为患者可能会根据感知的敏锐度自行选择护理地点。在2009年10月由美国急诊医师学会主办的医疗保健研究和质量资助会议上，我们提出了一项关于美国急性、计划外护理的研究议程，题为“提高急诊护理的质量和效率：一种系统方法”。随着越来越多的人加入保险，未来几年急诊科的使用率可能会增加，了解急诊科或诊所治疗条件在成本、质量和可及性方面的差异将对指导国家卫生政策至关重要。
For acutely ill patients, health care services are available in many different settings, including hospital-based emergency departments (EDs), retail clinics, federally qualified health centers, and outpatient clinics. Certain conditions are the sole domain of particular settings: stabilization of critically ill patients can typically only be provided in EDs. By contrast, many conditions that do not require hospital resources, such as advanced radiography, admission, and same-day consultation can often be managed in clinic settings. Because clinics are generally not open nights, and often not on weekends or holidays, the ED remains the only option for face-to-face medical care during these times. For patients who can be managed in either setting, there are many open research questions about which is the best setting, because these venues differ in terms of access, costs of care, and potentially, quality. Consideration of these patients must be risk-adjusted, as patients may self-select a venue for care based upon perceived acuity. We present a research agenda for acute, unscheduled care in the United States developed in conjunction with an Agency for Healthcare Research and Quality-funded conference hosted by the American College of Emergency Physicians in October 2009, titled "Improving the Quality and Efficiency of Emergency Care Across the Continuum: A Systems Approach." Given the possible increase in ED utilization over the next several years as more people become insured, understanding differences in cost, quality, and access for conditions that may be treated in EDs or clinic settings will be vital in guiding national health policy.