Practical alternative to hospitalization for emergency department patients (PATH): A feasibility study.
Practical alternative to hospitalization for emergency department patients (PATH): A feasibility study.
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DOI：
10.1016/j.hjdsi.2021.100545
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Chaiyachati KH
中科院分区：
文献类型：
--
作者：
Kilaru AS;Resnick D;Flynn D;Rangnekar A;Snyder M;Oyekanmi K;Fitzpatrick D;Meisel ZF;Asch DA;Chaiyachati KH
我们试图确定实际替代住院（PATH）计划的可行性，这是一种干预措施，为ED临床医生提供最初指定住院或观察的患者的门诊护理途径。我们评估了2019年12月在一家三级学术医疗中心试点的一种新型医疗服务模式。高级实践提供者筛选患者指定住院或观察，并确定符合条件的参与者。门诊服务为每位患者量身定制，但主要包括通过远程医疗和家庭保健服务进行护理协调和监测。主要可行性结果是纳入该计划的符合条件的患者比例，以及出院后的患者结果，包括急诊回访和避免急诊住院时间。共有199名患者被指定在PATH项目时间内住院或观察。在52例符合条件的患者中，30例（58%）入组。参与者的平均年龄为62.5岁（SD 17.5）， 25人（83%）是非西班牙裔黑人种族/民族。最常见的疾病是胸痛、心力衰竭和高血糖。4例（13%）入组患者在30天内返回急诊科。我们估计每位患者的ED登机时间减少了8.2小时（SD 8.1）。急诊医生和病人都愿意使用一种新颖的服务，为住院治疗提供了另一种选择。寻求降低医院利用率和成本的替代支付模式可以考虑加强系统来监测和协调急诊科出院后患者的护理。
We sought to determine the feasibility of the Practical Alternative to Hospitalization (PATH) program, an intervention that offers ED clinicians an outpatient care pathway for patients initially designated for inpatient admission or observation. We evaluated a novel care delivery model that was piloted at a tertiary academic medical center in December 2019. An advanced practice provider screened patients designated for inpatient admission or observation and identified eligible participants. Outpatient services were customized for each patient but primarily included care coordination and monitoring through telemedicine and home health services. The primary feasibility outcome was the proportion of eligible patients who were enrolled in the program, as well as patient outcomes after discharge including return ED visits and averted ED boarding time. A total of 199 patients were designated for inpatient admission or observation during PATH program hours. Of 52 eligible patients, 30 (58%) were enrolled. The mean participant age was 62.5 years (SD 17.5), and 25 (83%) had non-Hispanic Black race/ethnicity. The most common disease conditions were chest pain, heart failure, and hyperglycemia. 4 (13%) enrolled patients returned to an ED within 30 days. We estimate that ED boarding time was reduced by 8.2 h (SD 8.1) per patient. Emergency physicians and patients were willing to use a novel service that provided an alternative disposition to hospitalization. alternative payment models that seek to reduce hospital utilization and cost may consider strengthening systems to monitor and coordinate care for patients after ED discharge.
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