Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
Am J Emerg Med. 2013 Jan;31(1):16-9. doi: 10.1016/j.ajem.2012.05.001. Epub 2012 Jul 15.
The objective of this study was to determine factors that impact emergency department (ED) utilization among the most frequent ED users.
This prospective observational study consisting of questionnaires was conducted in an urban ED with an annual census of 95000 patients. A convenience sample of the top 1% of adult frequent users (≥9 ED visits in the previous 12 months) was enrolled from February 2009 to March 2010. Patients were excluded because of intoxication, altered mental status, or acute psychosis.
A total of 115 patients were enrolled, with an average age of 44 years and median number of 22 ±13 ED visits in the preceding 12 months. Seventy-eight percent of frequent users reported adequate health insurance coverage, and 75% reported one or more chronic medical conditions. Despite the high rates of insured patients, 75% identified the ED as their primary health care site. Half of the cohort had 2 or more hospital admissions over the past 12 months, of which 24% were patients with end-stage renal disease.
The top 1% of frequent users usually had adequate health insurance and primary care access but were burdened by chronic conditions and frequent hospital admissions. Such patients may require more extensive coordinated medical management to decrease ED utilization.
本研究旨在确定影响急诊（ED）最频繁使用者就诊的因素。
这是一项前瞻性观察研究，包括问卷调查，在一个每年有 95000 名患者就诊的城市急诊室进行。2009 年 2 月至 2010 年 3 月，从成人高频使用者（过去 12 个月就诊次数≥9 次）中抽取 1%的患者作为方便样本进行入组。因中毒、意识状态改变或急性精神病而排除患者。
共纳入 115 例患者，平均年龄为 44 岁，过去 12 个月的 ED 就诊次数中位数为 22±13 次。78%的高频使用者报告有足够的健康保险覆盖，75%报告有 1 种或多种慢性疾病。尽管参保患者比例较高，但 75%的患者将 ED 作为其主要医疗保健场所。该队列中有一半的患者在过去 12 个月中有 2 次或更多次住院，其中 24%的患者患有终末期肾病。
高频使用者中通常有足够的健康保险和初级保健服务，但受慢性疾病和频繁住院的困扰。这些患者可能需要更广泛的协调医疗管理，以减少 ED 的使用。
