Revisit Rates and Associated Costs After an Emergency Department Encounter A Multistate Analysis
Revisit Rates and Associated Costs After an Emergency Department Encounter A Multistate Analysis
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DOI：
10.7326/m14-1616
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发表时间：
2015-06-02
影响因子：
39.2
通讯作者：
Dudley, R. Adams
中科院分区：
文献类型：
--
作者：
Duseja, Reena;Bardach, Naomi S.;Dudley, R. Adams
背景：急诊科 (ED) 或医院在一次 ED 就诊后的回访给卫生系统带来了压力，但有关复诊率和复诊率决定因素的信息有限。目的：描述复诊率、按诊断和州划分的复诊率变化以及相关费用。设计：使用医疗保健成本和利用项目数据库进行观察性研究。背景：美国 6 个州。患者：2006 年至 2006 年期间曾就诊过 ED 的成年人 2010。测量：复诊率和费用。结果：在急诊科就诊后 3 天内，8.2% 的患者进行了复诊；其中 32% 的回访发生在不同的机构。复诊率因诊断而异，其中皮肤感染的复诊率最高。 （23.1% [95% Cl，22.3% 至 23.9%]）。重访率也因州而异。对于皮肤感染，佛罗里达州的风险调整后重访率（24.8% [Cl，23.5% 至 26.2%]）高于内布拉斯加州（10.6% [Cl，9.2% 至 12.1%]）。在佛罗里达州，唯一拥有完整费用数据的州，19.8% 的 30 天内复诊患者的总复诊费用占所有患者（包括有和没有复诊的患者）总指数 ED 就诊费用的 118%。 局限性：复诊是否反映了初级保健机会不足、计划复诊、患者不遵守 ED 建议或初次 ED 就诊时护理质量差仍然未知。结论： 指数 ED 遭遇后的重访比之前报道的更为频繁，部分原因是许多事件发生在指数机构之外。在佛罗里达州的急诊患者中，用于复诊的资源多于用于急诊就诊的资源。
Background: Return visits to the emergency department (ED) or hospital after an index ED visit strain the health system, but information about rates and determinants of revisits is limited.Objective: To describe revisit rates, variation in revisit rates by diagnosis and state, and associated costs.Design: Observational study using the Healthcare Cost and Utilization Project databases.Setting: 6 U.S. states.Patients: Adults with ED visits between 2006 and 2010.Measurements: Revisit rates and costs.Results: Within 3 days of an index ED visit, 8.2% of patients had a revisit; 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis, with skin infections having the highest rate. (23.1% [95% Cl, 22.3% to 23.9%]). Revisit rates also varied by state. For skin infections, Florida had higher risk-adjusted revisit rates (24.8% [Cl, 23.5% to 26.2%]) than Nebraska (10.6% [Cl, 9.2% to 12.1%]). In Florida, the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days were 118% of total index ED visit costs for all patients (including those with and without a revisit).Limitation: Whether a revisit reflects inadequate access to primary care, a planned revisit, the patient's nonadherence to ED recommendations, or poor-quality care at the initial ED visit remains unknown.Conclusion: Revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits.