Improving the quality of patient care and outcomes for frequent emergency department visitors

 描述(由申请人提供)：急诊科就诊并非平均分配给所有患者；约8%的患者负责所有急诊科就诊2-4经常使用急诊科服务的人非常令人担忧，因为标准医疗系统不能充分满足他们的医疗需求，导致医疗成本增加，并有可能影响向所有急诊科患者提供的护理质量。1尽管经常使用急诊科的人是一个不同的人群，但人们很少知道如何根据资源使用情况将经常使用急诊科服务的人归类到特定的组别，以便进行目标导向的干预。了解经常使用急诊室的人群将指导有针对性的干预措施的发展，以有效地帮助这些复杂的患者，提高患者护理的质量，并降低医疗资源的使用。丹佛健康医疗中心是一个模范的公共、学术医疗系统，40最近创建了一个非卧床重症监护病房--DHMC重症门诊诊所(IOC)，高利用率的患者在IOC接受所有的门诊护理。该诊所的目标是保持高质量的护理并减少住院人数。我们相信， IOC是评估IOC的主要目标，作为评估IOC的组成部分在减少急诊室就诊次数和避免过度使用医疗资源方面是否有效的“自然实验”。第一个假设是，存在不同类别的经常使用ED的人，他们具有不同的特征和ED资源使用的集群，将服从于定制的、有针对性的干预措施，以减少医疗资源的使用并提高患者护理的质量。第二个假设是，向经常使用ED的用户提供特定的IOC服务确实会导致更少的ED访问，并且IOC将被证明对经常使用ED的用户具有覆盖范围、有效性、采用率、实施和维护。第三个假设是，在丹佛健康教育部门对经常使用ED的人进行试点干预将是可行的；该干预措施将在教育部门采用和实现，同时对提供者和参与者是有用和及时的。因此，具体目标包括：(1)建立经常使用ED的用户及其使用的服务的分类法；(2)根据目标1中确定的分类法进行改进，以评估DHMC IOC对频繁访问ED的影响；以及(3)根据从IOC吸取的经验，在丹佛健康ED中设计和实施一项试点干预措施，专门旨在减少ED的访问和避免过度使用。

 DESCRIPTION (provided by applicant): Emergency department (ED) visits are not distributed equally amongst all patients; approximately 8% of patients are responsible for 28% of all ED visits.2-4 Frequent users of ED services are of significant concern as their healthcare needs are not adequately being met by the standard care system resulting in increased healthcare costs and the potential to impact the quality of care provided to all ED patients.1 While frequent ED users are a heterogeneous population, little is known about ways to classify frequent ED users along resource use into specific groups amenable to goal-directed interventions. Understanding frequent ED user groups will guide the development of targeted interventions to effectively assist these complex patients, improve the quality of patient care, and lower healthcare resource use. The Denver Health Medical Center, a model public, academic healthcare system, 40 recently created an ambulatory intensive caring unit, the DHMC Intensive Outpatient Clinic (IOC), in which high-utilizing patients receive all of their outpatient care in the IOC. The goal o the clinic is to maintain a high quality of care and decrease hospitalizations. We believe that the IOC is a prime target for evaluation as a "natural experiment" to assess whether components of the IOC are effective at reducing recurrent ED visits and avoiding overutilization of healthcare resources. The first hypothesis is that distinct categories of frequent ED users with differing characteristics and clusters of ED resource use exist that will be amenable to tailored, targeted interventions to reduce healthcare resource use and improve the quality of patient care. The second hypothesis are that specific IOC services provided to frequent ED users do result in fewer ED visits and that the IOC will be demonstrated to have reach, efficacy, adoption, implementation, and maintenance for frequent ED users. The third hypotheses are that a pilot intervention for frequent ED users will be feasible in the Denver Health ED; the intervention will be adopted and achievable in the ED while being useful and timely for providers and participants. The Specific Aims therefore include: (1) to create a taxonomy of frequent ED users and the services they utilize; (2) refined by the taxonomy identified in Aim 1, to evaluate the impact of the DHMC IOC on frequent ED visits; and (3) to design and implement a pilot intervention in the Denver Health ED targeted specifically at decreasing ED visits and avoiding overutilization based upon lessons learned from the IOC.