Trueger Nathan Seth, Chua Kao-Ping, Hussain Aamir, Liferidge Aisha T, Pitts Stephen R, Pines Jesse M
*Department of Emergency Medicine, Northwestern University Departments of †Pediatrics, Section of Academic Pediatrics ‡Public Health Sciences §Pritzker School of Medicine, University of Chicago, Chicago, IL ∥Department of Emergency Medicine ¶Miliken Institute School of Public Health, George Washington University, Washington, DC #Department of Emergency Medicine, Emory University, Atlanta, GA **Office for Clinical Practice Innovation, George Washington University, Washington, DC.
Med Care. 2017 Jul;55(7):693-697. doi: 10.1097/MLR.0000000000000733.
Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed.
To develop methods to incorporate the variability in alternative care site characteristics into estimates of ED visit "substitutability."
RESEARCH DESIGN, SUBJECTS, AND MEASURES: Our approach uses the range of hours and capabilities among alternative care sites to estimate lower and upper bounds of ED visit substitutability. We constructed "basic" and "extended" criteria that captured the plausible degree of variation in each site's hours and capabilities. To illustrate our approach, we analyzed data from 22,697 ED visits by adults in the 2011 National Hospital Ambulatory Medical Care Survey, defining a visit as substitutable if it was treat-and-release and met both the operating hours and functional capabilities criteria.
Use of the combined basic hours/basic capabilities criteria and extended hours/extended capabilities generated lower and upper bounds of estimates. Our criteria classified 5.5%-27.1%, 7.6%-20.4%, and 10.6%-46.0% of visits as substitutable in primary care offices, retail clinics, and urgent care centers, respectively.
Alternative care sites vary widely in operating hours and functional capabilities. Methods such as ours may help incorporate this variability into estimates of ED visit substitutability.
近期多项旨在提高医疗保健价值的努力都聚焦于减少那些有可能在替代医疗机构（即初级保健办公室、零售诊所和紧急护理中心）得到治疗的急诊科就诊人次。对这些就诊人次数量的估计可能取决于对替代医疗机构营业时间和功能能力的假设。然而，尚未开发出考虑这些特征变异性的方法。
开发将替代医疗机构特征的变异性纳入急诊科就诊“可替代性”估计的方法。
研究设计、研究对象和测量方法：我们的方法利用替代医疗机构之间的营业时间范围和功能能力来估计急诊科就诊可替代性的下限和上限。我们构建了“基本”和“扩展”标准，以捕捉每个机构营业时间和功能能力的合理变化程度。为说明我们的方法，我们分析了2011年全国医院门诊医疗调查中22,697名成年人的急诊科就诊数据，将一次就诊定义为可替代的，如果它是治疗后即出院且符合营业时间和功能能力标准。
使用基本营业时间/基本功能能力标准和扩展营业时间/扩展功能能力标准得出了估计的下限和上限。我们的标准分别将5.5%-27.1%、7.6%-20.4%和10.6%-46.0%的就诊归类为在初级保健办公室、零售诊所和紧急护理中心可替代。
替代医疗机构在营业时间和功能能力方面差异很大。像我们这样的方法可能有助于将这种变异性纳入急诊科就诊可替代性的估计中。
