Yiadom Maame Yaa A B, Baugh Christopher W, Jenkins Cathy A, Collins Sean P, Bhatia Monisha C, Dittus Robert S, Storrow Alan B
Department of Emergency Medicine, Nashville, TN.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
Acad Emerg Med. 2017 Dec;24(12):1527-1530. doi: 10.1111/acem.13279. Epub 2017 Oct 12.
From 2005 to 2010 health care financing shifts in the United States may have affected care transition practices for emergency department (ED) patients with nonspecific chest pain (CP) after ED evaluation. Despite being less acutely ill than those with myocardial infarction, these patients' management can be challenging. The risk of missing acute coronary syndrome is considerable enough to often warrant admission. Diagnostic advances and reimbursement limitations on the use of inpatient admission are encouraging the use of alternative ED care transition practices. In the setting of these health care changes, we hypothesized that there is a decline in inpatient admission rates for patients with nonspecific CP after ED evaluation.
We retrospectively used the Nationwide ED Sample to quantify total and annual inpatient hospital admission rates from 2006 to 2012 for patients with a final ED diagnosis of nonspecific CP. We assessed the change in admission rates over time and stratified by facility characteristics including safety-net hospital status, U.S. geographic region, urban/teaching status, trauma-level designation, and hospital funding status.
The admission rate for all patients with a final ED diagnosis of nonspecific CP declined from 19.2% in 2006 to 11.3% in 2012. Variability across regions was observed, while metropolitan teaching hospitals and trauma centers reflected lower admission rates.
There was a 41.1% decline in inpatient hospital admission for patients with nonspecific CP after ED evaluation. This reduction is temporally associated with national policy changes affecting reimbursement for inpatient admissions.
2005年至2010年期间，美国医疗保健融资的变化可能影响了急诊科（ED）对非特异性胸痛（CP）患者进行评估后的护理过渡措施。尽管这些患者的病情不如心肌梗死患者严重，但对他们的管理仍具有挑战性。漏诊急性冠状动脉综合征的风险相当高，往往需要住院治疗。诊断技术的进步以及住院治疗报销的限制促使人们采用替代的急诊科护理过渡措施。在这些医疗保健变化的背景下，我们假设急诊科评估后非特异性胸痛患者的住院率有所下降。
我们回顾性地利用全国急诊科样本，对2006年至2012年最终急诊科诊断为非特异性胸痛的患者的住院总数和年住院率进行量化。我们评估了住院率随时间的变化，并按机构特征进行分层，包括安全网医院状态、美国地理区域、城市/教学状态、创伤级别指定和医院资金状况。
最终急诊科诊断为非特异性胸痛的所有患者的住院率从2006年的19.2%降至2012年的11.3%。观察到各地区存在差异，而大都市教学医院和创伤中心的住院率较低。
急诊科评估后非特异性胸痛患者的住院率下降了41.1%。这一下降在时间上与影响住院报销的国家政策变化相关。
