Kindermann Dana R, Mutter Ryan L, Houchens Robert L, Barrett Marguerite L, Pines Jesse M
Department of Emergency Medicine, The Permanente Medical Group, Oakland, CA.
Acad Emerg Med. 2015 Feb;22(2):166-71. doi: 10.1111/acem.12589. Epub 2015 Jan 29.
In this study, the objective was to characterize emergency department (ED) transfer relationships and study the factors that predict the stability of those relationships. A metric is derived for ED transfer relationships that may be useful in assessing emergency care regionalization and as a resource for future emergency medicine research.
Emergency department records at transferring hospitals were linked to ED and inpatient records at receiving hospitals in nine U.S. states using the 2010 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases, the American Hospital Association Annual Survey, and the Trauma Information Exchange Program. Using the Clinical Classification Software to categorize conditions, high transfer rate conditions were placed into nine clinical groups. The authors created a new measure, the "transfer instability index," which estimates the effective number of "transfer partners" for each sending ED: this is designed to measure the stability of outgoing transfer relationships, where higher values of the index indicate less stable relationships. The index provides a measure of how many hospitals a transferring hospital sends its patients to (weighted by how often each transfer partner is used). Regression was used to analyze factors associated with higher values of the index.
Sending hospitals had a median of 3.5 effective transfer partners across all conditions. The calculated transfer instability indices varied from 1 to 2.4 across disease categories. In general, higher index values were associated with treating a higher proportion of publicly insured patients: 10 and 12% increases in the Medicare and Medicaid share of ED encounters, respectively, were associated with 10 and 14% increases in the effective number of transfer partners. This public insurance effect held while studying all conditions together as well as within individual disease categories, such as cardiac, neurologic, and traumatic conditions.
United States EDs that transfer patients to other hospitals often have multiple transfer partners. The stability of the transfer relationship, assessed by the transfer instability index, differs by condition. Less stable transfer relationships (i.e., hospitals with greater numbers of transfer partners) were more common in EDs with higher proportions of publicly insured patients.
本研究旨在描述急诊科（ED）的转诊关系，并探究预测这些关系稳定性的因素。推导了一种用于急诊科转诊关系的指标，该指标可能有助于评估急诊医疗区域化，并作为未来急诊医学研究的资源。
利用2010年医疗成本和利用项目州急诊科数据库、州住院患者数据库、美国医院协会年度调查以及创伤信息交换项目，将转诊医院的急诊科记录与美国九个州接收医院的急诊科和住院患者记录相链接。使用临床分类软件对病情进行分类，高转诊率病情被归入九个临床组。作者创建了一个新的指标，即“转诊不稳定指数”，用于估计每个转诊急诊科的“转诊伙伴”有效数量：该指标旨在衡量转出转诊关系的稳定性，指数值越高表明关系越不稳定。该指数衡量了一家转诊医院将患者转至多少家医院（根据每个转诊伙伴的使用频率加权）。采用回归分析与指数较高值相关的因素。
在所有病情中，转诊医院的转诊伙伴有效数量中位数为3.5个。不同疾病类别的计算出的转诊不稳定指数在1至2.4之间变化。一般来说，指数值越高与治疗的公费参保患者比例越高相关：急诊就诊中医疗保险和医疗补助份额分别增加10%和12%，与转诊伙伴有效数量分别增加10%和14%相关。在综合研究所有病情以及在诸如心脏、神经和创伤等个别疾病类别中，这种公费保险效应均成立。
将患者转至其他医院的美国急诊科通常有多个转诊伙伴。通过转诊不稳定指数评估的转诊关系稳定性因病情而异。在公费参保患者比例较高的急诊科中，转诊关系不太稳定（即转诊伙伴数量较多的医院）更为常见。
