McConnell K John, Newgard Craig D, Lee Raymond
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
Ann Emerg Med. 2008 Dec;52(6):635-642. doi: 10.1016/j.annemergmed.2008.01.338. Epub 2008 Apr 3.
We measure changes in the prevalence and magnitude of stipends and other payments for taking emergency call during a 2-year period for hospitals in Oregon and evaluate the ways in which hospitals are limiting services and assessing policy options.
This was a longitudinal, standardized, e-mail-based survey of chief executive officers from all hospitals with emergency departments (EDs) in Oregon (N=56). The first wave was conducted in the summer of 2005; a follow-up survey was conducted in summer 2006. Hospitals reported on-call payments made to 8 selected specialties.
Among 56 Oregon hospitals with EDs, 43 responded to our survey in both 2005 and 2006, representing a 77% response rate. Among 54 specialties receiving stipends in 2006, the average stipend was $18,324. Total annual stipend payments increased by 84%, from an average of $227,000 per hospital in 2005 to $487,000 per hospital in 2006. In Oregon, between 2004 and 2006, 67% of hospitals lost the ability to provide coverage for at least 1 specialty on a 24-hour, 7-day-a-week basis. Approximately half of hospitals (49%) manage this lack of coverage by transferring patients to other hospitals on a case-by-case, ad hoc basis.
The cost of maintaining on-call coverage is increasing in Oregon, raising concerns about hospital financing and a degradation of the emergency services. There has not been a systematic response to on-call shortages, with patient transfers primarily managed in an ad hoc, case-by-case basis.
我们对俄勒冈州各医院在两年期间因承担急诊值班而获得的津贴及其他报酬的发生率和幅度变化进行了测量，并评估了医院限制服务的方式以及政策选择。
这是一项针对俄勒冈州所有设有急诊科（ED）的医院的首席执行官进行的纵向、标准化的基于电子邮件的调查（N = 56）。第一波调查于2005年夏季进行；后续调查于2006年夏季进行。医院报告了向8个选定专科支付的值班报酬。
在俄勒冈州的56家设有急诊科的医院中，有43家在2005年和2006年都回复了我们的调查，回复率为77%。在2006年获得津贴的54个专科中，平均津贴为18,324美元。年度津贴支付总额增长了84%，从2005年每家医院平均227,000美元增至2006年每家医院平均487,000美元。在俄勒冈州，2004年至2006年期间，67%的医院失去了每周7天、每天24小时为至少1个专科提供服务的能力。约一半的医院（49%）通过逐案、临时将患者转至其他医院的方式来应对这种服务覆盖不足的情况。
在俄勒冈州，维持值班服务覆盖的成本在增加，这引发了对医院融资和急诊服务质量下降的担忧。对于值班短缺问题尚未有系统性的应对措施，患者转院主要是在临时、逐案的基础上进行管理。
