ED Use Patterns Antecedents and Consequences in Older Adults

老年人 ED 使用模式的前因和后果

• 批准号: 7354424
• 负责人: Fredric D Wolinsky
• 金额: $ 18.33万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-02-15 至 2010-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7354424
• 关键词: Academic Medical Centers; Accident and Emergency department; Admission activity; Aged, 80 and over; Aging; Ambulances; Ambulatory Care; American; Beds; Behavioral Sciences; Calendar; Caring; Cessation of life; Characteristics; Charge; Chronic Care; Climate; Clinical; Code; Common Good; Communities; Condition; Consumption; Continuity of Patient Care; Count; County; Cox Models; Crowding; Current Procedural Terminology Codes; Daily; Data; Data Collection; Data Sources; Diagnosis; Diagnostic; Disease; Disease regression; Economics; Education; Elderly; Emergency Care; Emergency Medicine; Epidemic; Equation; Equilibrium; Evaluation; Event; Failure; Future; Geriatrics; Gerontology; Health; Health Expenditures; Health Insurance; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Individual; Inpatients; Institute of Medicine (U.S.); Interview; Lead; Life; Linear Models; Link; Logistics; Marketing; Measurement; Measures; Medicaid; Medicare; Medicare Part A; Methodology; Mission; Mitochondrial Carnitine Palmitoyltransferase Pathway; Modeling; Morals; Numbers; Outcome; Outpatients; Patients; Pattern; Personal Satisfaction; Persons; Physicians; Policies; Population; Preventive; Price; Production; Publishing; Range; Recording of previous events; Regression Analysis; Relative (related person); Reporting; Research; Resources; Sampling; Services; Side; Solutions; Source; Specialist; Standards of Weights and Measures; Structure; System; Technology; Textiles; Time; Title; Trauma; Typology; Uninsured; United States; Visit; Vital Status; Writing; base; behavioral/social science; beneficiary; burden of illness; cost; data structure; follow-up; frailty; health care delivery; hospital admission rate; indexing; injured; interest; mortality; payment; programs; response; socioeconomics; trauma centers

DESCRIPTION (provided by applicant): In its 2006 Report of the Committee on the Future of Emergency Care in the United States Health System, the IOM bluntly declared that there is a national epidemic of overcrowded EDs [Emergency Departments] and trauma centers. In simple economic terms, a critical imbalance exists between supply and demand. Unfortunately, little population-based research exists that focuses on demand factors for individual ED visits, and no studies have been published on demand factors for ED use patterns over time. We propose to develop one or more typologies that reflect an older adults pattern of ED use over time (as opposed to focusing on single ED visits) among a nationally representative sample of Medicare beneficiaries (Specific Aim 1), and to examine the antecedents (Specific Aim 2) and consequences (Specific Aim 3) of these ED use patterns. We focus on older adults because in 2003 Medicare paid for 16% of the 114 million ED visits, providing it with a monopsonistic ability to intervene via payment policy. We will link data from four sources. The first is the 1993 baseline and 1995, 1998, 2000, 2002, and 2004 follow-up interviews with the 7,447 non-institutionalized individuals who participated in the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). These subjects were born before 1924 and were 70 years old or older at baseline. The second data source is the National Death Index (NDI), which contains vital status information on the AHEAD subjects through December 31, 2004. The third data source is the geocode identifiers for the AHEAD subjects at each wave of data collection. The final data source is the Medicare Part A and B claims for the AHEAD subjects that will be available for calendar years 1989 through 2004. The typologies for Specific Aim 1 will be developed based on CPT relative intensity codes and ICD9-CM diagnostic codes, as well as their relationship to criterion validity measures, such as hospital admission rates, arrival by ambulance, proportional share of all health care received in the ED, and mortality. Specific Aim 2 will be evaluated focusing first on individual ED visits using hierarchical (three levels: ED visits, subject, county) generalized linear modeling. Although a comprehensive set of covariates will be included, we are especially interested in education, the characteristics of the local health care delivery system, and continuity of care. We will then focus on modeling ED use patterns using similar two-level (person and county) models. In Specific Aim 3 the appropriate two-level, multivariable statistical models (Cox frailty regression for the time to the first dated event like hospitalization for ACSCs or mortality, binomial regression for constrained-range count variables like the number of hospital episodes, and Poisson regression for skewed extended-range variables like physician visits and total charges), will first estimate the crude effects of the given set of ED use pattern dummy variables, and then decompose these effects by sequentially introducing standard covariates. In its 2006 Report of the Committee on the Future of Emergency Care in the United States Health System, the IOM bluntly declared that there is a national epidemic of overcrowded EDs [Emergency Departments] and trauma centers. Unfortunately, little population-based research exists that focuses on demand factors for individual ED visits, and no studies have been published on demand factors for ED use patterns over time. We propose to develop one or more typologies that reflect an older adults pattern of ED use over time (as opposed to focusing on single ED visits) among a nationally representative sample of Medicare beneficiaries (Specific Aim 1), and to examine the antecedents (Specific Aim 2) and consequences (Specific Aim 3) of these ED use patterns.

描述（由申请人提供）：在其2006年美国卫生系统急诊护理未来委员会报告中，IOM直言不讳地宣布，急诊科和创伤中心过度拥挤是一种全国性的流行病。 用简单的经济术语来说，供求之间存在严重的不平衡。不幸的是，很少有基于人口的研究，重点是个人艾德访问的需求因素，并没有研究已发表的需求因素艾德使用模式随着时间的推移。我们建议开发一个或多个类型学，反映老年人随着时间的推移使用艾德的模式（而不是专注于单一的艾德访问）在全国代表性的样本医疗保险受益人（具体目标1），并检查这些艾德使用模式的前因（具体目标2）和后果（具体目标3）。我们把重点放在老年人身上，因为在2003年，医疗保险支付了1.14亿次艾德就诊中的16%，为它提供了通过支付政策进行干预的能力。我们将从四个来源收集数据。第一个是1993年的基线和1995年，1998年，2000年，2002年和2004年的后续采访的7,447名非机构化的个人谁参加了资产和健康动态研究中的最古老的老人（AHEAD）。这些受试者出生于1924年之前，基线时年龄≥ 70岁。第二个数据源是国家死亡指数（NDI），其中包含截至2004年12月31日AHEAD受试者的生命状态信息。第三个数据源是每一波数据收集中AHEAD主题的地理编码标识符。最终数据来源是AHEAD受试者的Medicare A部分和B部分索赔，将在1989年至2004年期间提供。具体目标1的类型学将基于CPT相对强度代码和ICD 9-CM诊断代码，以及它们与标准有效性指标的关系，如住院率、救护车到达、在艾德接受的所有医疗保健的比例份额和死亡率。将使用分层（三个级别：艾德访视、受试者、县）广义线性模型，首先对具体目标2进行评价，重点关注个体艾德访视。虽然一套全面的协变量将被包括在内，我们特别感兴趣的是教育，当地卫生保健提供系统的特点，和护理的连续性。然后，我们将重点关注使用类似的两级（个人和县）模型对艾德使用模式进行建模。在具体目标3中，适当的两水平多变量统计模型（考克斯脆弱性回归用于至首次事件（如ACSC住院或死亡）的时间，二项式回归用于限制范围计数变量（如住院次数），泊松回归用于偏态扩展范围变量（如医生访视和总费用）），将首先估计给定的一组艾德使用模式虚拟变量的粗效应，然后通过顺序引入标准协变量来分解这些效应。在2006年美国卫生系统急诊护理未来委员会的报告中，国际移民组织直言不讳地宣布，急诊室和创伤中心人满为患的现象在全国范围内普遍存在。 不幸的是，很少有基于人口的研究，重点是个人艾德访问的需求因素，并没有研究已发表的需求因素艾德使用模式随着时间的推移。我们建议开发一个或多个类型学，反映老年人随着时间的推移使用艾德的模式（而不是专注于单一的艾德访问）在全国代表性的样本医疗保险受益人（具体目标1），并检查这些艾德使用模式的前因（具体目标2）和后果（具体目标3）。