Emergency Department Increased use of Observation Care for Elderly Medicare Patients.
Emergency Department Increased use of Observation Care for Elderly Medicare Patients.
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DOI：
10.5430/jha.v7n3p9
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发表时间：
2018-06-01
期刊：
影响因子：
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通讯作者：
Sarkisian, Catherine A
中科院分区：
文献类型：
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作者：
Gabayan, Gelareh Z;Liang, Li-Jung;Sarkisian, Catherine A
背景：在过去的十年中，越来越多的老年医疗保险受益人去急诊科就诊，并被置于观察护理中。我们调查和比较了年龄为65岁的≥患者的患病率和相关因素，这些患者在急诊室就诊后被安置在医院、观察护理或出院。方法：我们使用2013年具有全国代表性的5%的年龄为≥65岁的医疗保险患者的数据进行了一项回溯性队列研究。结果：在2013年≥65岁的537,455名医疗保险受益人中，48.0%(N=258,083)患者出院，10.5%(N=56,184)接受观察护理，41.5%(N=223,188)在急诊室就诊后住院。与入院与出院相关的前两位诊断是缺血性心脏病和肾脏疾病。有症状的患者，如胸痛和头晕，在急诊室就诊后比入院时更有可能被置于观察护理中。结论：与以往的研究相比，我们发现老年医疗保险ED患者被置于观察护理中的人数更多，入院的人数更少。观察护理中最常见的诊断是基于症状的，而入院的诊断是基于疾病的。
BACKGROUND: Over the past decade, a growing number of older Medicare beneficiaries visit the Emergency Department (ED) and have been placed in observation care. We investigated and compared the prevalence and factors associated with patients age ≥ 65 years with Medicare insurance who are placed in the hospital, observation care, or discharged following an ED visit.METHODS: We conducted a retrospective cohort study using data from a nationally representative 5% sample of Medicare patients age ≥ 65 years during the year 2013. We performed multiple generalized estimating equation (GEE) logistic regression analyses to assess the relationship between placement in a hospital vs. discharge, observation care vs. discharge, and observation care vs. admission.RESULTS: Of 537,455 Medicare beneficiaries age ≥ 65 years who visited an ED in 2013, 48.0% (N= 258,083) were discharged, 10.5% (N=56,184) placed in observation care, and 41.5% (N=223,188) were admitted to the inpatient service following the ED visit. The top 2 diagnoses associated with placement in the hospital vs. discharge were ischemic heart disease and renal disease. Patients with symptomatic diagnoses such as chest pain and dizziness were more likely to be placed in observation care following an ED visit as compared to admission to the hospital.CONCLUSION: Compared to prior studies, we found a greater number of older Medicare ED patients placed in observation care and a lower number admitted to the hospital. Most common diagnoses of placement in observation care were symptom-based as compared to being admitted to the hospital which were disease-based.