Murphy Sean M, Neven Darin
Department of Health Policy and Administration, Washington State University, Spokane, Washington.
Consistent Care Program, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington.
J Emerg Med. 2014 Aug;47(2):223-31. doi: 10.1016/j.jemermed.2013.11.073. Epub 2014 Feb 6.
Frequent and unnecessary utilization of the emergency department (ED) is often a sign of serious latent patient issues, and the associated costs are shared by many. Helping these patients get the care they need in the appropriate setting is difficult given their complexity, and their tendency to visit multiple EDs.
We analyzed the cost-effectiveness of a multidisciplinary ED-care-coordination program with a regional hospital information system capable of sharing patients' individualized care plans with cooperating EDs.
ED visits, treatment costs, cost per visit, and net income were assessed pre- and postenrollment in the program using nonparametric bootstrapping techniques. Individuals were categorized as frequent (3-11 ED visits in the 365 days preceding enrollment) or extreme (≥12 ED visits) users. Regression to the mean was tested using an adjusted measure of change.
Both frequent and extreme users experienced significant decreases in ED visits (5 and 15, respectively; 95% confidence intervals [CI] 2-5 and 13-17, respectively) and direct-treatment costs ($1285; 95% CI $492-$2364 and $6091; 95% CI $4298-$8998, respectively), leading to significant hospital cost savings and increased net income ($431; 95% CI $112-$878 and $1925; 95% CI $1093-$3159, respectively). The results further indicate that fewer resources were utilized per visit. Regression to the mean did not seem to be an issue.
When examined as a whole, research on the program suggests that expanding it would be an efficient allocation of hospital, and possibly societal, resources.
急诊科（ED）的频繁且不必要的使用往往是患者潜在严重问题的一个迹象，并且相关成本由许多人共同承担。鉴于这些患者情况复杂且倾向于前往多个急诊科就诊，要帮助他们在合适的环境中获得所需的护理是困难的。
我们分析了一个多学科急诊科护理协调项目的成本效益，该项目配备了一个能够与合作的急诊科共享患者个性化护理计划的区域医院信息系统。
使用非参数自助法技术评估项目入组前后的急诊科就诊次数、治疗成本、每次就诊成本和净收入。个体被分类为频繁使用者（入组前365天内有3 - 11次急诊科就诊）或极端使用者（≥12次急诊科就诊）。使用调整后的变化量度来检验均值回归。
频繁使用者和极端使用者的急诊科就诊次数均显著减少（分别减少5次和15次；95%置信区间分别为2 - 5次和13 - 17次），直接治疗成本也显著降低（分别为1285美元；95%置信区间为492 - 2364美元和6091美元；95%置信区间为4298 - 8998美元），从而显著节省了医院成本并增加了净收入（分别为431美元；95%置信区间为112 - 878美元和1925美元；95%置信区间为1093 - 3159美元）。结果还表明每次就诊所使用的资源减少。均值回归似乎不是一个问题。
总体来看，对该项目的研究表明扩大该项目将是医院乃至社会资源的有效配置。
