Birmingham Lauren E, Cochran Thaddeus, Frey Jennifer A, Stiffler Kirk A, Wilber Scott T
Department of Emergency Medicine, Summa Health System, 525 E. Market Street, Akron, OH, 44304, USA.
Department of Health Policy and Management, College of Public Health, Kent State University, 750 Hilltop Drive, Kent, OH, 44240, USA.
BMC Emerg Med. 2017 May 10;17(1):16. doi: 10.1186/s12873-017-0126-5.
There is no common understanding of how needs of emergency department (ED) frequent users differ from other patients. This study sought to examine how to best serve this population. Examinations of why ED frequent users present to the ED, what barriers to care exist, and what service offerings may help these patients achieve an optimal level of health were conducted.
We performed a prospective study of frequent ED users in an adult only, level 1 trauma center with approximately 90,000 visits per year. Frequent ED users were defined as those who make four or more ED visits in a 12 month period. Participants were administered a piloted structured interview by a trained researcher querying demographics, ED usage, perceived barriers to care, and potential aids to maintaining health.
Of 1,523 screened patients, 297 were identified as frequent ED users. One hundred frequent ED users were enrolled. The mean age was 48 years (95% CI 45-51). The majority of subjects were female (64%, 64/100, 95% CI 55-73%), white (61%, 60/98, 95% CI 52-71%) and insured by Medicaid (55%, 47/86, 95% CI 44-65%) or Medicare (23%, 20/86, 95% CI 14-32%). Subjects had a median of 6 ED visits, and 2 inpatient admissions in the past 12 months at this hospital. Most frequent ED users (61%, 59/96, 95% CI 52-71%) stated the primary reason for their visit was that they felt that their health problem could only be treated in an ED. Transportation presented as a major barrier to few patients (7%, 7/95, 95% CI 3-14%). Subjects stated that "after-hours options, besides the ED for minor health issues" (63%, 60/95, 95% CI 53-73%) and having "a nurse to work with you one-on-one to help manage health care needs" (53%, 50/95, 95% CI 43-63%) would be most helpful in achieving optimal health.
This study characterized ED frequent users and identified several opportunities to better serve this population. By understanding barriers to care from the patient perspective, health systems can potentially address unmet needs that prevent wellness in this population.
对于急诊科频繁使用者的需求与其他患者的需求有何不同，目前尚无共识。本研究旨在探讨如何最好地服务这一人群。研究分析了急诊科频繁使用者前往急诊科的原因、存在哪些护理障碍以及哪些服务可能有助于这些患者达到最佳健康水平。
我们在一家仅收治成人的一级创伤中心对急诊科频繁使用者进行了一项前瞻性研究，该中心每年约有90000人次就诊。急诊科频繁使用者定义为在12个月内就诊4次或更多次的患者。由一名经过培训的研究人员对参与者进行试点结构化访谈，询问人口统计学信息、急诊科使用情况、感知到的护理障碍以及维持健康的潜在辅助因素。
在1523名筛查患者中，297名被确定为急诊科频繁使用者。招募了100名急诊科频繁使用者。平均年龄为48岁（95%置信区间45 - 51岁）。大多数受试者为女性（64%，64/100，95%置信区间55 - 73%）、白人（61%，60/98，95%置信区间52 - 71%），由医疗补助计划（55%，47/86，95%置信区间44 - 65%）或医疗保险（23%，20/86，95%置信区间14 - 32%）承保。受试者在过去12个月内在该医院的急诊科就诊中位数为6次，住院2次。大多数急诊科频繁使用者（61%，59/96，95%置信区间52 - 71%）表示就诊的主要原因是他们觉得自己的健康问题只能在急诊科得到治疗。交通问题对少数患者（7%，7/95，95%置信区间3 - 14%）来说是一个主要障碍。受试者表示，“除了急诊科外，针对小健康问题的非工作时间选择”（63%，60/95，95%置信区间53 - 73%）以及“有一名护士与您一对一合作以帮助满足医疗保健需求”（53%，50/95，95%置信区间43 - 63%）对实现最佳健康最有帮助。
本研究对急诊科频繁使用者进行了特征描述，并确定了几个更好地服务这一人群的机会。通过从患者角度了解护理障碍，医疗系统有可能解决那些阻碍这一人群健康的未满足需求。
