McWilliams Andrew, Tapp Hazel, Barker Jolene, Dulin Michael
School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
N C Med J. 2011 Jul-Aug;72(4):265-71.
Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (ACSCs). The unnecessary use of emergency departments (EDs) is an expensive burden on hospitals and payers. Here, we identify factors influencing ED visits for ACSCs and analyze the costs of such visits for EDs and primary care clinics.
Age, race, sex, and insurance data from 2007 for 3 primary care safety net clinics and 4 EDs in Charlotte, North Carolina, were analyzed using the New York University (NYU) algorithm to identify ACSC diagnoses. Cost analyses used hospital charge data and net margins as surrogates for payer and hospital system costs.
A total of 113,730 (59.4%) of 191,622 ED visits were for ACSCs. Factors that increased the number of ACSC-related visits included lack of insurance coverage; receipt of Medicaid insurance; age of less than 2 years; African American, Hispanic, or Native American race or ethnicity; and female sex. Charges in the EDs were 320%-728% higher than those in the primary care clinics, allowing for a potential savings of 69%-86% had ACSCs been treated in primary care clinics instead of in EDs.
The NYU algorithm may have inherent weaknesses in the categorization of ACSC-related visits and the accuracy of cost assignment, especially for vulnerable patients, such as those with comorbidities or those aged less than 2 years.
The majority of conditions treated during outpatient ED visits are treatable in primary care clinics or even preventable. Some groups are at higher risk for inappropriate use of EDs. Solutions to this complex problem will require payers and hospital systems to design and invest in novel targeted interventions.
患者经常因门诊护理敏感型疾病（ACSCs）不适当地寻求急诊服务。急诊科（EDs）的不必要使用给医院和支付方带来了高昂负担。在此，我们确定影响ACSCs患者急诊就诊的因素，并分析此类就诊给急诊科和基层医疗诊所带来的成本。
使用纽约大学（NYU）算法分析了2007年北卡罗来纳州夏洛特市3家基层医疗安全网诊所和4家急诊科的年龄、种族、性别和保险数据，以确定ACSCs诊断。成本分析使用医院收费数据和净利润作为支付方和医院系统成本的替代指标。
在191,622次急诊就诊中，共有113,730次（59.4%）是因ACSCs。增加ACSCs相关就诊次数的因素包括缺乏保险覆盖；接受医疗补助保险；年龄小于2岁；非裔美国人、西班牙裔或美洲原住民种族或族裔；以及女性。急诊科的收费比基层医疗诊所高出320% - 728%，如果ACSCs在基层医疗诊所而非急诊科接受治疗，可能节省69% - 86%的费用。
NYU算法在ACSCs相关就诊的分类和成本分配准确性方面可能存在固有弱点，尤其是对于患有合并症或年龄小于2岁的弱势患者。
门诊急诊就诊期间治疗的大多数疾病在基层医疗诊所是可治疗的，甚至是可预防的。一些群体不适当使用急诊科的风险较高。解决这个复杂问题需要支付方和医院系统设计并投资于新型有针对性的干预措施。
