Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina; Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina; Ambulatory Care Service, Veterans Affairs Medical Center, Durham, North Carolina; Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina; Center for the Study of Aging and Human Development, Duke University, Duke University School of Medicine, Durham, North Carolina.
J Am Geriatr Soc. 2014 Apr;62(4):711-5. doi: 10.1111/jgs.12746. Epub 2014 Mar 17.
To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions.
Secondary analysis.
Medicare Current Beneficiary Survey.
Adults aged 65 and older with at least one treat-and-release ED visit between January 1, 2000, and September 30, 2007 (N = 4,964).
Measures of health service use included primary care visits, treat-and-release ED visits, and hospital days in the 12 months preceding the index ED visit.
Five groups of individuals in the ED with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care visits. "Wellderly" (34%) had fewer visits of all types than other groups. "Chronically Illderly" (14%) had the highest mean number of primary care visits and hospital days. "Acute Carederly" (9.8%) had lowest mean number of primary care visits but higher ED visits and hospital days than all other groups except the "Sickest Elderly." Sickest Elderly (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. Primary Carederly and Wellderly had a lower risk of hospital admission within 30 days of the index ED visit than the other groups.
In older adults released from an ED, group membership was associated with future health services use. Classification of individuals using readily available previous visit data may improve targeting of interventions to improve outcomes.
根据医疗保健的使用情况对急诊科（ED）的老年人进行分类，并研究群体归属与未来 ED 就诊和住院之间的关联。
二次分析。
医疗保险当前受益人调查。
2000 年 1 月 1 日至 2007 年 9 月 30 日期间至少有一次治疗后离院的 ED 就诊的 65 岁及以上成年人（N=4964）。
健康服务使用的测量指标包括初级保健就诊、治疗后离院的 ED 就诊和在指数 ED 就诊前 12 个月内的住院天数。
在 ED 中发现了 5 组具有不同健康服务使用模式的个体。“初级保健依赖者”（39%）ED 和医院就诊率较低，而初级保健就诊次数较高。“健康高龄者”（34%）比其他组就诊次数更少。“慢性重病者”（14%）初级保健就诊次数和住院天数最高。“急性保健依赖者”（9.8%）初级保健就诊次数最低，但 ED 就诊和住院天数高于除“最病重老年人”以外的所有其他组。“最病重老年人”（3.2%）ED 就诊次数最多；平均住院天数是其他任何组的四倍多。在指数 ED 就诊后 30 天内，初级保健依赖者和健康高龄者的住院风险低于其他组。
在从 ED 出院的老年人中，群体归属与未来的卫生服务使用相关。使用可获得的先前就诊数据对个体进行分类，可能有助于针对改善结局的干预措施进行目标定位。
