What Drives Frequent Emergency Department Use in an Integrated Health System? National Data From the Veterans Health Administration
What Drives Frequent Emergency Department Use in an Integrated Health System? National Data From the Veterans Health Administration
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DOI：
10.1016/j.annemergmed.2013.02.016
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发表时间：
2013-08-01
影响因子：
6.2
通讯作者：
Rosenheck, Robert A.
中科院分区：
文献类型：
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作者：
Doran, Kelly M.;Raven, Maria C.;Rosenheck, Robert A.
研究目的：急诊科（ED）患者的频繁使用引起了广泛关注。我们在全国退伍军人健康管理局（VHA）中确定了与ED频繁使用最密切相关的社会人口统计学和临床因素。方法：我们对2010年全国VHA数据库（N=5,531,379）进行了横断面分析。主要结局指标是VHA ED就诊次数，分为6个频率水平。结果：2010年，4600667例（83.2%）VHA患者没有ED就诊，其中1次就诊的493391例（8.9%），2 ~ 4次就诊的356258例（6.4%），5 ~ 10次就诊的70741例（1.3%），11 ~ 25次就诊的9705例（0.2%），25次以上就诊的617例（0.01%）。ED使用频率的增加与无家可归、医疗诊断、药物滥用和精神病诊断、接受精神药物和阿片类药物处方以及更频繁地使用门诊医疗和心理健康服务有关。在多变量分析中，与所有ED使用水平最密切相关的因素是精神分裂症（优势比[OR]范围为1.44[95%置信区间{Cl} 1.41至1.47]至6.86 [95% Cl 5.55至8.48]），无家可归（OR范围为1.41 [95% CI 1.38至1.43]至6.60 [95% Cl 5.36至8.12]），阿片类药物处方（OR范围为2.09 [95% Cl 2.07至2.10]至5.08 [95% Cl 4.16至6.19]），和心力衰竭（OR范围1.64 [95% Cl 1.63至1.66]至3.53 [95% Cl 2.64至4.72]）。结论：频繁使用急诊科甚至发生在一个协调的卫生保健系统，提供现成的门诊护理。频繁急诊科使用者的特点是表现出高水平的社会心理和医疗需求。我们确定的频繁使用ED的相关因素在多个不同水平的ED使用中是一致的。
Study objective: There is widespread concern about patients with frequent emergency department (ED) use. We identify sociodemographic and clinical factors most strongly associated with frequent ED use within the Veterans Health Administration (VHA) nationally.Methods: We conducted a cross-sectional analysis of national VHA databases (N=5,531,379) in 2010. The primary outcome measure was the number of VHA ED visits categorized into 6 frequency levels.Results: In 2010, 4,600,667 (83.2%) VHA patients had no ED visit, whereas 493,391 (8.9%) had 1 visit, 356,258 (6.4%) had 2 to 4 visits, 70,741 (1.3%) had 5 to 10 visits, 9,705 (0.2%) had 11 to 25 visits, and 617 (0.01%) had greater than 25 visits. Increasing ED use frequency was associated with homelessness, medical diagnoses, substance abuse and psychiatric diagnoses, receipt of psychotropic and opioid prescriptions, and more frequent use of outpatient medical and mental health services. In multivariable analyses, factors most strongly associated with all levels of ED use were schizophrenia (odds ratio [OR] range 1.44 [95% confidence interval {Cl} 1.41 to 1.47] to 6.86 [95% Cl 5.55 to 8.48] across categories of increasing ED use), homelessness (OR range 1.41 [95% CI 1.38 to 1.43] to 6.60 [95% Cl 5.36 to 8.12]), opioid prescriptions filled (OR range 2.09 [95% Cl 2.07 to 2.10] to 5.08 [95% Cl 4.16 to 6.19]), and heart failure (OR range 1.64 [95% Cl 1.63 to 1.66] to 3.53 [95% Cl 2.64 to 4.72]).Conclusion: Frequent ED use occurs even in a coordinated health care system that provides ready access to outpatient care. Frequent ED users are characterized by traits that represent high levels of psychosocial and medical needs. The correlates we identified for frequent ED use were consistent across multiple distinct levels of ED use.