Henry Ford Health System, Detroit, MI.
West J Emerg Med. 2010 Sep;11(4):348-53.
To determine if the effective use of Health Information Technologies (HIT) and the Electronic Medical Record (EMR) affects emergency department (ED) usage in a complicated frequently presenting patient population.
A retrospective, observational study of 45 patients enrolled in our Frequent User Program called Community Resources for Emergency Department Overuse (CREDO) between June 2005 and July 2007. The study was conducted at an urban hospital with greater than 95,000 annual visits. Patients served as their own historical controls. In this pre-post study, the pre-intervention control period was determined by the number of months the patient had been enrolled in the program. The pre- and post-intervention time periods were the same for each patient but varied between patients. The intervention included using HIT to identify the most frequently presenting patients and creating individualized care plans for those patients. The care plans were made available through the EMR to all healthcare providers. Study variables in this study intervention included ED charges, lab studies ordered, number of ED visits, length of stay (LOS), and Total Emergency Department Contact Time (TEDCT), which is the product of the number of visits and the LOS. We analyzed these variables using paired T-tests. This study was approved by the institutional review board.
Forty-five patients were enrolled, but nine were excluded for no post enrollment visits; thus, statistical analysis was conducted with n=36. The ED charges decreased by 24% from $64,721 to $49,208 (p=0.049). The number of lab studies ordered decreased by 28% from 1847 to 1328 (p=0.04). The average number of ED visits/patient decreased by 25% from 67.4 to 50.5 (p=0.046). The TEDCT decreased by 39% from 443.7 hours to 270.6 hours (p=0.003).
In this pre-post analysis of an intervention targeting ED frequent users, the use of HIT and the EMR to identify patients and store easily accessible care plans significantly reduced ED charges, labs ordered, number of ED visits, and the TEDCT.
确定有效利用健康信息技术（HIT）和电子病历（EMR）是否会影响复杂频繁就诊患者群体的急诊科（ED）就诊情况。
这是一项回顾性观察性研究，纳入了 2005 年 6 月至 2007 年 7 月期间参加我们的“急诊过度使用社区资源计划”（Community Resources for Emergency Department Overuse，CREDO）的 45 名患者。该研究在一家拥有超过 95000 次年度就诊量的城市医院进行。患者作为自己的历史对照。在这项前后对照研究中，干预前的对照期由患者入组该计划的月数决定。每个患者的干预前和干预后时间段相同，但在患者之间有所不同。干预措施包括使用 HIT 识别最常就诊的患者，并为这些患者制定个性化的护理计划。这些护理计划通过 EMR 提供给所有医疗保健提供者。本研究的干预变量包括 ED 费用、医嘱检验检查、ED 就诊次数、住院时间（LOS）和总急诊科接触时间（Total Emergency Department Contact Time，TEDCT），后者是就诊次数和 LOS 的乘积。我们使用配对 T 检验分析了这些变量。该研究得到了机构审查委员会的批准。
共纳入 45 名患者，但有 9 名患者因入组后无就诊而被排除；因此，对 n=36 名患者进行了统计学分析。ED 费用从 64721 美元降至 49208 美元，降幅为 24%（p=0.049）。医嘱检验检查数量从 1847 项降至 1328 项，降幅为 28%（p=0.04）。每位患者的 ED 就诊次数从 67.4 次降至 50.5 次，降幅为 25%（p=0.046）。TEDCT 从 443.7 小时降至 270.6 小时，降幅为 39%（p=0.003）。
在针对 ED 高频就诊患者的这项干预措施的前后对照分析中，使用 HIT 和 EMR 来识别患者并存储易于获取的护理计划，显著降低了 ED 费用、医嘱检验检查数量、ED 就诊次数和 TEDCT。
