Frazier Rosyland, Doucette Sanna
Institute of Social and Economic Research, University of Alaska Anchorage, AK 99508, USA.
Int J Circumpolar Health. 2013 Aug 5;72. doi: 10.3402/ijch.v72i0.21344. eCollection 2013.
In 2004, 5 remote clinics--4 in rural frontier communities in Alaska and 1 in Washington--were funded to pilot and examine the effectiveness and appropriateness of a new facility model. Transporting patients from these locations to higher levels of care is not always possible requiring these facilities to expand their scope of services and provide care for extended periods. The Frontier Extended Stay Clinic (FESC) model is staffed and equipped to provide the combined services usually found in the separate settings of an outpatient primary-care clinic, inpatient acute care hospital and emergency room. This is a descriptive study of the characteristics of these pilot facilities and an analysis of patient utilization and outcomes.
The 5 clinics collected outcome data for 2,226 extended-stay encounters of 4 hours or longer from 15 September 2005 to 14 September 2010. Data from these extended-stay encounters were summarized, and descriptive statistics were used to describe: number and duration of encounters, when the encounters started, chief compliant, discharge diagnoses, transfer destination, Medicare and Medicaid eligibility, and type of encounter.
From 2005 to 2010, the mean duration of an extended-stay encounter was 9.1 hours. All of the clinics experienced many extended-stay encounters that were initiated or continued after normal business hours. The 5 most frequent diagnoses at discharge for extended encounters were cardiovascular, gastrointestinal, injury, substance abuse and pneumonia/bronchitis. Almost half, 47.6%, of extended-stay encounters resulted in discharge of the patient without a need for either non-urgent follow-up referral or transport. Extended-stay encounters that ended in a patient being transported to another medical facility were 43.7% of the total. More than a quarter (26.9%) of extended-stay encounters were eligible for Medicare payment.
While many of communities can support a facility for primary care, there is an on-going need for facilities in remote frontier areas to also provide emergent and extended-stay care. The FESC can provide access to primary, emergent and extended-stay services in these locations.
2004年，5家偏远诊所——4家位于阿拉斯加农村边境社区，1家位于华盛顿州——获得资金，用于试行和检验一种新设施模式的有效性和适用性。将这些地区的患者转运至更高水平的医疗机构并非总是可行，这就要求这些诊所扩大服务范围并提供更长时间的护理。边境延长住院诊所（FESC）模式配备了人员和设备，可提供通常在门诊初级保健诊所、住院急症医院和急诊室等不同场所提供的综合服务。这是一项对这些试点诊所特征的描述性研究，以及对患者利用率和治疗结果的分析。
这5家诊所收集了2005年9月15日至2010年9月14日期间2226次时长4小时或更长时间的延长住院诊疗的结果数据。对这些延长住院诊疗的数据进行了汇总，并使用描述性统计数据来描述：诊疗次数和时长、诊疗开始时间、主要诉求、出院诊断、转诊目的地、医疗保险和医疗补助资格以及诊疗类型。
2005年至2010年期间，延长住院诊疗的平均时长为9.1小时。所有诊所都经历了许多在正常营业时间之后开始或持续的延长住院诊疗。延长诊疗出院时最常见的5种诊断是心血管疾病、胃肠道疾病、损伤、药物滥用以及肺炎/支气管炎。几乎一半（47.6%）的延长住院诊疗在患者出院时无需进行非紧急随访转诊或转运。以患者被转运至另一家医疗机构结束的延长住院诊疗占总数的43.7%。超过四分之一（26.9%）的延长住院诊疗符合医疗保险支付条件。
虽然许多社区能够支持初级保健设施，但偏远边境地区仍然需要能够提供急诊和延长住院护理的设施。FESC模式能够在这些地区提供初级、急诊和延长住院服务。
