美国急诊部 1993 年至 2005 年中级提供者的使用情况：对劳动力的影响。

Use of midlevel providers in US EDs, 1993 to 2005: implications for the workforce.

机构信息

Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.

出版信息

Am J Emerg Med. 2010 Jan;28(1):90-4. doi: 10.1016/j.ajem.2008.09.028.

DOI:10.1016/j.ajem.2008.09.028

PMID:20006209

Abstract

OBJECTIVE

The aim of the study was to evaluate use of physician assistants (PAs) and nurse practitioners (NPs) in US emergency departments (EDs).

METHODS

We analyzed visits from the 1993 to 2005 National Hospital Ambulatory Medical Care Survey, seen by midlevel provider (MLP), and compared characteristics of MLP visits to those seen by physicians only.

RESULTS

From 1993 to 2005, 5.2% (95% CI, 4.6%-5.8%) of US ED visits were seen by PAs and 1.7% (95% CI, 1.5%-2.0%) by NPs. During the study period, PA visits rose from 2.9% to 9.1%, whereas NP visits rose from 1.1% to 3.8% (both P(trend) < .001). Compared to physician only visits, those seen only by MLPs arrived by ambulance less frequently (6.0% vs 15%), had lower urgent acuity (37% vs 59%), and were admitted less often (3.0% vs 13%).

CONCLUSIONS

Midlevel provider use has increased in US EDs. Their involvement in some urgent visits and those requiring admission suggests that the role of MLPs extends beyond minor presentations.

摘要

目的

本研究旨在评估美国急诊部（ED）中医生助理（PA）和执业护士（NP）的使用情况。

方法

我们分析了 1993 年至 2005 年全国医院门诊医疗调查中的就诊记录，这些记录由中级医疗提供者（MLP）就诊，并将 MLP 就诊与仅由医生就诊的记录进行了比较。

结果

1993 年至 2005 年期间，美国 ED 就诊中有 5.2%（95%可信区间，4.6%-5.8%）由 PA 就诊，1.7%（95%可信区间，1.5%-2.0%）由 NP 就诊。在研究期间，PA 就诊从 2.9%上升至 9.1%，而 NP 就诊从 1.1%上升至 3.8%（两者 P（趋势）<0.001）。与仅由医生就诊的记录相比，仅由 MLP 就诊的患者乘坐救护车就诊的频率较低（6.0% vs 15%），紧急程度较低（37% vs 59%），住院率较低（3.0% vs 13%）。