PA-20-070 Identifying Predictors of Hospital Admission from the ED Among the Elderly

项目总结： 正在进行的新冠肺炎大流行对紧急护理产生了巨大影响。来自世界各地的报道 该国建议急诊科就诊于非冠状病毒相关疾病，如急性心肌梗死和 中风下降了30%-50%，坊间数据表明，非COVID患者的总访问量 相关情况也有所减少。以向ED报告为条件，大流行也在发生变化 急诊科提供者如何处理接纳病人入院的决定。可能有多个 参与这一决策的动机，有些与系统层面的因素有关，如能力限制 还有一些与个别患者住院风险和好处评估的变化有关。 急诊科(ED)是美国入院人数的主要来源。超过70%的 医疗保险患者的住院费用来自急诊科，医疗保险的额外费用1 不同地区、不同医院、甚至不同医生的急诊室入院率差别很大 在医院内。迫切需要确定与新冠肺炎相关的因素的程度 流行病已经改变了ED中的提供者决策，以及这些决策是否与 对病人的伤害更大。从这些分析中吸取的经验教训将对指导教育提供者 在这场大流行的未来阶段以及类似的情况下，探讨是否接纳 可能出现的情况。此外，对于一些非冠状病毒相关的情况，存在一种可能性 新冠肺炎之前的住院率太高(低价值入院)，而现在的入院率 更优化。因此，提供保健服务的效率可能会有较长期的改善。 这一系统可以通过优化使用住院医院护理获得，这是其最昂贵的组成部分。 这项拟议的研究将利用医疗保险受益人及其护理提供者的数据来实现三个目标 主要目标。使用来自联邦医疗保险计划目标1的具有全国代表性的数据将检查以下方面的程度 新冠肺炎大流行对该国部分地区急诊就诊率的影响更大 而且受大流行的影响较小。第二个目标是研究教育署如何作出收生决定。 都受到了影响。最后，目标3将检查入院变化对患者预后的影响。 包括30天死亡率和ED复诊。第二个和第三个目标将使用严格的准实验 方法比较受影响较大和影响较小的国家地区的感兴趣结果的变化 新冠肺炎大流行。我们的中心假设是，录取率将会下降(在 广泛的非新冠肺炎相关疾病)在大流行期间， 将看到受新冠肺炎影响特别严重的地区，这些下降在 入院率将与较差的临床结果相关。

Project Summary: The ongoing COVID-19 pandemic has had a dramatic impact on emergency care. Reports from around the country suggest that ED visits for non-COVID related conditions such as acute myocardial infarction and stroke have plummeted by 30-50%, and anecdotal data suggests that overall visit volume for non-COVID related conditions has also decreased. Conditional on presenting to the ED, the pandemic also is changing how ED providers approach the decision to admit a patient to the hospital. There may be a number of motivations involved in this decision-making, some related to system-level factors such as capacity constraints and some related to changes in assessments of the risks and benefits of hospitalization for individual patients. The emergency department (ED) is the primary source for hospital admissions in the US. Over 70% of hospital admissions among Medicare patients originate from the ED at an extraordinary cost to Medicare.1 Rates of hospital admission from the ED vary widely across regions, hospitals, and even across physicians within hospitals. A critical need exists to determine the extent to which factors related to the COVID-19 pandemic have altered provider decision-making in the ED and whether these decisions are associated with greater harm for patients. Lessons learned from these analyses will be vital to guiding ED providers in approaching the decision to admit during future phases of this pandemic as well as under similar circumstances that might arise. Moreover, there is a possibility that for some non-COVID related conditions hospitalization rates pre-COVID-19 were too high (low-value admissions), and that admission rates are now more optimal. Thus, there could be longer term improvements in the efficiency of the health care delivery system that can be gained by optimizing the use of inpatient hospital care, its most expensive component. The proposed study will utilize data on Medicare beneficiaries and their care providers to accomplish three key aims. Using nationally representative data from the Medicare program aim 1 will examine the extent to which the COVID-19 pandemic has impacted ED visit rates for specific diagnoses in parts of the country more and less effected by the pandemic. The second aim will then examine how admission decisions from the ED have been impacted. Finally, aim 3 will examine the impact of changes in admission on patient outcomes including 30-day mortality and ED revisits. The second and third aims will use rigorous quasi-experimental methods to compare changes in the outcomes of interest in areas of the country more and less impacted by the COVID-19 pandemic. Our central hypotheses are that the rate of admission will be decreased (across a broad array of non-COVID-19 related conditions) during the time of the pandemic, that greater decreases in admission will be seen for areas that were particularly impacted by COVID-19, and that these decreases in admission rates will be associated with worse clinical outcomes.