Amber K. Sabbatini is an instructor of emergency medicine at the University of Washington, in Seattle.
Brahmajee K. Nallamothu is an associate professor of cardiovascular medicine at the University of Michigan; a core investigator at the Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center; a faculty member at the Center for Healthcare Outcomes and Policy; and a faculty member at the Institute for Healthcare Policy and Innovation, all in Ann Arbor.
Health Aff (Millwood). 2014 Sep;33(9):1655-63. doi: 10.1377/hlthaff.2013.1318.
The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions.
急诊科（ED）现在是美国医院住院的主要来源，不同 ED 的各种原因的入院率差异很大。在这项研究中，我们使用了 ED 就诊的全国样本，研究了 ED 之间风险标准化入院率的差异，以及这种差异与十五种最常见的内科和外科住院疾病的住院死亡率之间的关系。然后，我们根据不同的利用情况估计了这种变化对国家卫生支出的影响。风险标准化的入院率在 ED 之间存在显著差异，从脓毒症的 1.03 倍到胸痛的 6.55 倍，这是就诊人数第 25 到第 75 百分位之间的差异。胸痛、软组织感染、哮喘、慢性阻塞性肺疾病和尿路感染等低死亡率疾病的差异最大。这表明，其中一些住院治疗可能不是必需的，因此有机会提高效率并降低医疗支出。我们的数据表明，如果能缩小这些高变异性、低死亡率疾病中 ED 住院治疗实践之间的差异，美国支付者可能会节省大量费用。
