A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department
A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department
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DOI：
10.1016/j.annemergmed.2012.05.042
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发表时间：
2013-03-01
影响因子：
6.2
通讯作者：
Landon, Bruce E.
中科院分区：
文献类型：
--
作者：
Smulowitz, Peter B.;Honigman, Leah;Landon, Bruce E.
本文介绍了一种新的框架，根据严重程度的大类对急诊科（艾德）就诊进行分类，确定最有可能降低与ED相关成本的就诊类别。尽管直接归因于艾德的成本节约往往是在改革后的支付系统下运营的组织的重要重点，我们的框架表明，与旨在减少入院的策略相比，将低敏度就诊从艾德转移的重点将导致更少的节省，并且在较小程度上提高艾德对中间或复杂状况的护理效率。我们的结论是，针对这些类别，而不是轻微的伤害/疾病，应该是教育署降低成本战略的主要重点。然后，我们讨论了这些发现对紧急护理系统融资的影响，该系统需要考虑艾德的“备用能力”所需的固定成本，并探索艾德可以更好地融入患者的方法-以医疗保健系统为中心。[Ann 2013;61：293-300.]
This article introduces a novel framework that classifies emergency department (ED) visits according to broad categories of severity, identifying those categories of visits that present the most potential for reducing costs associated with the ED. Although cost savings directly attributable to the ED are apt to be an important emphasis of organizations operating under reformed payment systems, our framework suggests that a focus on diverting low-acuity visits away from the ED would result in far less savings compared with strategies aimed at reducing admissions and to a lesser extent improving the efficiency of ED care for intermediate or complex conditions. We conclude that targeting these categories, rather than minor injuries/illnesses, should be the primary focus of cost-reduction strategies from the ED. Given this understanding, we then discuss the implications of these findings on the financing of an emergency care system that needs to account for the required fixed costs of "stand-by capacity" of the ED and explore ways in which the ED can be better integrated into a patient-centered health care system. [Ann Emerg Med. 2013;61:293-300.]