急诊科频繁就诊者：强化病例管理以减少就诊次数和计算机断层扫描的初步研究。
Emergency department frequent user: pilot study of intensive case management to reduce visits and computed tomography.
机构信息
David Geffen School of Medicine at University of California, Los Angeles.
出版信息
West J Emerg Med. 2010 Sep;11(4):336-43.
OBJECTIVE
Emergency department (ED) frequent users account for a large number of annual ED visits and often receive radiological studies as a part of their evaluation. We report a pilot study of a case management program for ED frequent users to reduce ED usage and radiation exposure.
METHODS
This observational retrospective study was performed at a community hospital ED. Between May 2006 and April 2008, 96 patients were enrolled in a case management program and were followed through November 2008. The case management program consisted of a multi-disciplinary team of physicians, nurses, social services and specialists in pain management and behavioral health. Patients were enrolled if they had five or more visits to the ED in the previous month, if a concern about a patient's ED use was raised by staff, or if they were identified by the California prescription monitoring program. Case management addressed specific patient issues and assisted with receiving consistent outpatient care. The number of ED visits per patient and the number of radiological studies at each of these visits was recorded. When reviewing data for analysis, we used the number of total images in all computed tomography (CT) scans during the given time period.
RESULTS
In the six months prior to enrollment, patients averaged 2.3 ED visits per patient per month. In the six months after enrollment, patients averaged 0.6 ED visits per patient per month (P<0.0001), and all visits after enrollment up to November 2008 averaged 0.4 visits per patient per month (P<0.0001). In the six months prior to enrollment, these patients averaged 25.6 CT images per patient per month. In the six months after enrollment, patients averaged 10.2 CT images per patient per month (P=0.001), and all CT images after enrollment up to November 2008 averaged 8.1 CT images per patient per month (P=0.0001). This represents a decrease in ED use by 83% and a decrease in radiation exposure by 67%.
CONCLUSION
Case management can significantly reduce ED use by frequent users, and can also decrease radiation exposure from diagnostic imaging.
目的
急诊（ED）频繁使用者占每年 ED 就诊量的很大比例，他们通常在评估过程中接受影像学研究。我们报告了一项针对 ED 频繁使用者的病例管理计划的试点研究，以减少 ED 使用量和辐射暴露。
方法
这项观察性回顾性研究在社区医院 ED 进行。在 2006 年 5 月至 2008 年 4 月期间，共有 96 名患者入组病例管理计划，并在 2008 年 11 月之前进行随访。病例管理计划由医生、护士、社会服务人员以及疼痛管理和行为健康方面的专家组成的多学科团队组成。如果患者在过去一个月内到 ED 就诊五次或以上、工作人员对患者的 ED 使用情况表示关注、或患者被加利福尼亚州处方监测计划识别，则将其纳入病例管理计划。病例管理解决了特定的患者问题，并协助获得一致的门诊护理。记录每位患者的 ED 就诊次数和每次就诊的影像学检查次数。在分析数据时，我们使用了在给定时间段内所有计算机断层扫描（CT）扫描的总图像数量。
结果
在入组前的六个月中，患者平均每月每位患者就诊 2.3 次。在入组后的六个月中，患者平均每月每位患者就诊 0.6 次（P<0.0001），并且截至 2008 年 11 月的所有就诊平均每月每位患者就诊 0.4 次（P<0.0001）。在入组前的六个月中，这些患者平均每月每位患者接受 25.6 次 CT 检查。在入组后的六个月中，患者平均每月每位患者接受 10.2 次 CT 检查（P=0.001），并且截至 2008 年 11 月的所有 CT 图像平均每月每位患者就诊 0.8 次（P=0.0001）。这表示 ED 使用量减少了 83%，辐射暴露量减少了 67%。
结论
病例管理可以显著减少 ED 频繁使用者的 ED 使用量，并减少诊断影像学检查的辐射暴露。
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