Yarris Lalena M, Moreno Raymond, Schmidt Terri A, Adams Annette L, Brooks Heather S
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA.
Acad Emerg Med. 2006 Apr;13(4):401-5. doi: 10.1197/j.aem.2005.11.079. Epub 2006 Mar 10.
To test a hypothesis that patients would accept alternatives to transport to an emergency department (ED) by ambulance and to evaluate factors related to patient willingness to consider alternatives. Concerns about resource utilization have prompted emergency medical services (EMS) systems to explore alternatives to ambulance transport to an ED, but studies have evaluated the safety of alternatives, not patient preferences.
Trained research assistants surveyed patients transported by ambulance to a university ED. Interfacility transfers, trauma patients, and critically ill patients were excluded. The primary outcome was willingness to accept one of several presented alternatives to ambulance transport to the ED for that visit. Demographic and clinical factors were evaluated for association with willingness to consider alternatives. Relative risks (RR) and 95% confidence intervals (95% CI) were determined by using Mantel-Haenszel stratified methods.
Three hundred fifteen subjects completed the survey. Two hundred forty-seven (78.4%) were willing to consider at least one alternative. One hundred ninety-four (61.6%) were willing to consider transportation by car, and 177 (56.2%) were willing to consider transportation by taxi. Factors associated with willingness to consider alternatives included the following: age 18-65 years (RR, 1.25; 95% CI = 1.03 to 1.49), being unemployed (RR, 1.08; 95% CI = 1.08 to 1.33), use of the ED for routine care (RR, 1.25; 95% CI = 1.17 to 1.35), and not being admitted to the hospital (RR, 1.19; 95% CI = 1.04 to 1.40). Race, gender, health insurance status, and EMS interventions en route were not associated with willingness to consider transportation alternatives.
Many patients transported by ambulance to an ED would have considered an alternative, if one were offered.
检验一个假设，即患者会接受救护车转运至急诊科（ED）以外的其他方式，并评估与患者考虑其他方式意愿相关的因素。对资源利用的担忧促使紧急医疗服务（EMS）系统探索救护车转运至急诊科以外的其他方式，但此前的研究评估的是这些替代方式的安全性，而非患者的偏好。
经过培训的研究助理对通过救护车转运至一所大学急诊科的患者进行了调查。排除机构间转运患者、创伤患者和危重症患者。主要结果是愿意接受此次就诊时救护车转运至急诊科的几种替代方式之一。评估人口统计学和临床因素与考虑替代方式意愿之间的关联。采用Mantel-Haenszel分层方法确定相对风险（RR）和95%置信区间（95%CI）。
315名受试者完成了调查。247名（78.4%）愿意考虑至少一种替代方式。194名（61.6%）愿意考虑乘坐汽车转运，177名（56.2%）愿意考虑乘坐出租车转运。与考虑替代方式意愿相关的因素包括：年龄18 - 65岁（RR，1.25；95%CI = 1.03至1.49）、失业（RR，1.08；95%CI = 1.08至1.33）、将急诊科用于常规护理（RR，1.25；95%CI = 1.17至1.35）以及未住院（RR，1.19；95%CI = 1.04至1.40）。种族、性别、健康保险状况以及途中的EMS干预与考虑转运替代方式的意愿无关。
许多通过救护车转运至急诊科的患者会考虑其他替代方式，如果提供的话。
