Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
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谁提供什么护理？国家急救人员临床重点分析。
DOI：
10.1016/j.ajem.2020.11.069
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Venkatesh AK
中科院分区：
文献类型：
--
作者：
Gettel CJ;Canavan ME;D'Onofrio G;Carr BG;Venkatesh AK
临床医生的专业知识与改善患者预后相关，但艾德临床医生通常在艾德以外的各种临床环境中工作，因此，可能会因临床重点较少而使专业知识面临风险。我们试图描述全国急诊护理队伍的临床重点。使用2017年医疗保险公共使用文件（PUF），我们对从医疗保险收费服务部分B获得紧急护理评估和管理（E/M）服务补偿的临床医生进行了横断面分析。临床医生按类型分为EM医生，非EM医生和高级实践提供者（APP）。主要结果是临床医生的临床重点，定义为在所有实践环境中，艾德环境中的E/M服务相对于临床医生的总E/M服务的比例。在艾德环境中为医疗保险付费服务受益人提供护理的65，710名独立临床医生中，39，016名（59.4%）被归类为EM医生，8，123名（12.4%）为非EM医生，18，571名（28.5%）为APP。EM医生的个体临床医生中位焦点为92.8%（四分位距[IQR]：87.0，100.0），非EM医生为45.2%（IQR：5.1，97.0），APP为100.0%（IQR：96.3，100.0）。与为医疗保险收费服务受益人提供紧急护理的非EM医生相比，EM医生的临床关注度是非EM医生的两倍。这些发现强调了多样化培训和认证计划的重要性，以确保获得临床重点艾德临床医生。
Clinician expertise has been associated with improved patient outcomes, yet ED clinicians often work in various clinical settings beyond the ED and, therefore, may risk expertise by having less clinical focus. We sought to describe clinical focus among the emergency care workforce nationally. Using the 2017 Medicare Public Use Files (PUF), we performed a cross-sectional analysis of clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services from Medicare fee-for-service Part B. Clinicians were categorized by type as EM physicians, non-EM physicians, and advanced practice providers (APPs). The primary outcome was the clinical focus of the individual clinician, defined as the proportion of E/M services within the ED setting relative to a clinician’s total E/M services across all practice settings. Of 65,710 unique clinicians providing care to Medicare fee-for-service beneficiaries in the ED setting, 39,016 (59.4%) were classified as EM physicians, 8,123 (12.4%) as non-EM physicians, and 18,571 (28.5%) as APPs. The individual clinician median focus was 92.8% (interquartile range [IQR]: 87.0, 100.0) for EM physicians, 45.2% (IQR: 5.1, 97.0) for non-EM physicians, and 100.0% (IQR: 96.3, 100.0) for APPs. EM physicians have twice as much clinical focus in comparison to non-EM physicians providing emergency care to Medicare fee-for-service beneficiaries. These findings underscore the importance of diverse training and certification programs to ensure access to clinically focused ED clinicians.
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影响因子：
6.2
作者：
Hall, M. Kennedy;Burns, Kevin;Venkatesh, Arjun
通讯作者：
Venkatesh, Arjun
影响因子：
9.7
作者：
Brar, Sandeep;McAlister, Finlay A.;Rowe, Brian H.
通讯作者：
Rowe, Brian H.
影响因子：
3.6
作者：
Unterman, Sarah;Kessler, Chad;Pitzele, H. Zoltan
通讯作者：
Pitzele, H. Zoltan
影响因子：
1.5
作者：
Wadman, MC;Muelleman, RL;Walker, RA
通讯作者：
Walker, RA
影响因子：
6.2
作者：
Kocher, Keith E.;Haggins, Adrianne N.;Sharp, Adam L.
通讯作者：
Sharp, Adam L.