Emergency Department Hospitalization Volume and Mortality in the United States
Emergency Department Hospitalization Volume and Mortality in the United States
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DOI：
10.1016/j.annemergmed.2014.06.008
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发表时间：
2014-11-01
影响因子：
6.2
通讯作者：
Sharp, Adam L.
中科院分区：
文献类型：
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作者：
Kocher, Keith E.;Haggins, Adrianne N.;Sharp, Adam L.
研究目的：尽管大量研究表明，在提供卫生服务方面，较高的数量与改善的结果之间存在关系，但尚未在急诊科（ED）环境中进行广泛探索。因此，我们试图检查急诊科住院量与常见高危疾病死亡率之间的关系。方法：使用来自全国住院病人样本（全国医院出院样本）的数据，我们评估了2005年至2009年间8种不同诊断的总体死亡率（总入院人数为1755万）。选择这些情况是因为它们是常见的（在所有急诊科住院的前25名中）和高风险的（观察到的死亡率为3%）。如果急诊科的年总入院人数不超过1000人，且没有30例特定疾病病例，则被排除在分析之外。然后根据住院容量将急诊科分为五分位数。使用回归技术来描述容量（每年住院ED患者的数量）与随后的早期住院死亡率（入院后2天内）和总体死亡率之间的关系，并根据患者和医院的特征进行调整。结果：死亡率随着体积的增加而下降，但体积的相对重要性因病情而异。非常大容量急诊科和非常小容量急诊科调整死亡率的绝对差异范围从败血症的-5.6%（95%可信区间[CI] -6.5%至-4.7%）到肺炎的-0.2%（95%可信区间[CI] -0.6%至0.1%）。总体而言，这一差异为-0.4% （95% CI -0.6%至-0.3%）。在评估早期医院死亡时也观察到类似的模式。结论：通过大容量急诊科就诊的患者住院死亡的可能性较低。
Study objective: Although numerous studies have demonstrated a relationship between higher volume and improved outcomes in the delivery of health services, it has not been extensively explored in the emergency department (ED) setting. Therefore, we seek to examine the association between ED hospitalization volume and mortality for common high-risk conditions.Methods: Using data from the Nationwide Inpatient Sample, a national sample of hospital discharges, we evaluated mortality overall and for 8 different diagnoses between 2005 and 2009 (total admissions 17.55 million). These conditions were chosen because they are frequent (in the top 25 of all ED hospitalizations) and high risk (>3% observed mortality). EDs were excluded from analysis if they did not have at least 1,000 total annual admissions and 30 disease-specific cases. EDs were then placed into quintiles based on hospitalized volume. Regression techniques were used to describe the relationship between volume (number of hospitalized ED patients per year) and both subsequent early inpatient mortality (within 2 days of admission) and overall mortality, adjusted for patient and hospital characteristics.Results: Mortality decreased as volume increased overall and for all diagnoses, but the relative importance of volume varied, depending on the condition. Absolute differences in adjusted mortality rates between very high-volume EDs and very low-volume EDs ranged from -5.6% for sepsis (95% confidence interval [CI] -6.5% to -4.7%) to -0.2% for pneumonia (95% CI -0.6% to 0.1%). Overall, this difference was -0.4% (95% CI -0.6% to -0.3%). A similar pattern was observed when early hospital deaths were evaluated.Conclusion: Patients have a lower likelihood of inhospital death if admitted through high-volume EDs.