Arnopolin S L, Smithline H A
Department of Emergency Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, Mass., USA.
JAAPA. 2000 Dec;13(12):39-40, 49-50, 53-4 passim.
Decreasing health care dollars have resulted in increased utilization of so-called midlevel practitioners. We compared emergency physicians with emergency department physician assistants (PAs) to determine whether PAs are an appropriate option for providing services rendered by physicians in this setting.
We undertook an observational retrospective review of a hospital database (July 1995 to June 1996) from an urban urgent-care facility. Collection of data was restricted to times of single-provider coverage. Every patient who visited the clinic was seen by the sole provider (physician or PA) on duty; no one was turned away. If a patient needed emergency care, he (or she) was transferred to the main emergency department at the hospital, as deemed appropriate by either provider after evaluation. Physicians and PAs were compared in regard to length of visit and total charges in 14 diagnostic groups. Adverse outcomes were not evaluated. Age, sex, race, and multiple diagnoses were controlled for by regression analysis.
A total of 9,601 patient encounters were analyzed. PAs and physicians had a similar distribution of diagnostic groups. Respiratory infection and musculoskeletal disorders accounted for approximately 36% of visits; lacerations, gastrointestinal disorders, and otitis each accounted for 5% of visits. Overall, visits were 8 minutes longer and total charges $8 less when a patient was treated by a PA. Patients who had headache, otitis, respiratory infection, asthma, gastrointestinal or genitourinary disorder, cellulitis, laceration, or other musculoskeletal disorder had a longer visit when seen by a PA; the difference ranged from 5 to 32 minutes longer. In no diagnostic group was there a statistically significant greater length of visit or total charge because patients were seen by a PA.
Despite a few large differences in some diagnostic groups, the two types of provider had, overall, small but clinically insignificant differences in length of visit and total charges. The magnitude of difference in length of visit and total charges strongly suggests that PAs, when compared with physicians, are a viable staffing option in an urgent care facility.
医疗保健费用的减少导致了所谓中级医疗从业者的使用增加。我们将急诊医生与急诊科医师助理（PA）进行比较，以确定在这种情况下PA是否是提供医生所提供服务的合适选择。
我们对一家城市紧急护理机构的医院数据库（1995年7月至1996年6月）进行了观察性回顾研究。数据收集仅限于单人值班时间。每个就诊的患者都由值班的唯一提供者（医生或PA）诊治；无人被拒诊。如果患者需要紧急护理，经任何一位提供者评估后认为合适，他（或她）将被转至医院的主要急诊科。在14个诊断组中，对医生和PA的就诊时长和总费用进行了比较。未评估不良结局。通过回归分析控制了年龄、性别、种族和多重诊断。
共分析了9601例患者就诊情况。PA和医生的诊断组分布相似。呼吸道感染和肌肉骨骼疾病约占就诊病例的36%；撕裂伤、胃肠道疾病和中耳炎各占就诊病例的5%。总体而言，患者由PA治疗时，就诊时间长8分钟，总费用少8美元。患有头痛、中耳炎、呼吸道感染、哮喘、胃肠道或泌尿生殖系统疾病、蜂窝织炎、撕裂伤或其他肌肉骨骼疾病的患者由PA诊治时就诊时间更长；差异在5至32分钟之间。在任何诊断组中，患者由PA诊治时，就诊时长或总费用均无统计学上的显著增加。
尽管在某些诊断组中存在一些较大差异，但总体而言，这两种类型的提供者在就诊时长和总费用方面存在微小但临床上无显著意义的差异。就诊时长和总费用的差异程度强烈表明，与医生相比，PA是紧急护理机构中一种可行的人员配置选择。
