Department of Emergency Medicine, Vanderbilt University, Nashville, TN.
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA.
Acad Emerg Med. 2018 Jan;25(1):65-75. doi: 10.1111/acem.13319.
Emergency department (ED) acuity is the general level of patient illness, urgency for clinical intervention, and intensity of resource use in an ED environment. The relative strength of commonly used measures of ED acuity is not well understood.
We performed a retrospective cross-sectional analysis of ED-level data to evaluate the relative strength of association between commonly used proxy measures with a full spectrum measure of ED acuity. Common measures included the percentage of patients with Emergency Severity Index (ESI) scores of 1 or 2, case mix index (CMI), academic status, annual ED volume, inpatient admission rate, percentage of Medicare patients, and patients seen per attending-hour. Our reference standard for acuity is the proportion of high-acuity charts (PHAC) coded and billed according to the Centers for Medicare and Medicaid Service's Ambulatory Payment Classification (APC) system. High-acuity charts included those APC 4 or 5 or critical care. PHAC was represented as a fractional response variable. We examined the strength of associations between common acuity measures and PHAC using Spearman's rank correlation coefficients (r ) and regression models including a quasi-binomial generalized linear model and linear regression.
In our univariate analysis, the percentage of patients ESI 1 or 2, CMI, academic status, and annual ED volume had statistically significant associations with PHAC. None explained more than 16% of PHAC variation. For regression models including all common acuity measures, academic status was the only variable significantly associated with PHAC.
Emergency Severity Index had the strongest association with PHAC followed by CMI and annual ED volume. Academic status captures variability outside of that explained by ESI, CMI, annual ED volume, percentage of Medicare patients, or patients per attending per hour. All measures combined only explained only 42.6% of PHAC variation.
急诊科（ED）的病情严重程度是指患者疾病的总体水平、临床干预的紧迫性和 ED 环境下资源使用的强度。常用 ED 病情严重程度测量指标的相对强度尚不清楚。
我们对 ED 级别的数据进行了回顾性横断面分析，以评估常用代理测量指标与 ED 病情严重程度全谱测量指标之间的关联强度。常用指标包括紧急严重程度指数（ESI）评分为 1 或 2 的患者百分比、病例组合指数（CMI）、学术地位、年度 ED 量、住院入院率、医疗保险患者百分比和每位主治医生每小时就诊患者数。我们将根据医疗保险和医疗补助服务中心（CMS）门诊支付分类（APC）系统编码和计费的高病情严重程度图表（PHAC）比例作为病情严重程度的参考标准。高病情严重程度图表包括 APC 4 或 5 或重症监护。PHAC 表示为分数响应变量。我们使用 Spearman 等级相关系数（r）和包括拟二项式广义线性模型和线性回归的回归模型来检查常见病情严重程度测量指标与 PHAC 之间的关联强度。
在我们的单变量分析中，ESI 评分 1 或 2 的患者百分比、CMI、学术地位和年度 ED 量与 PHAC 具有统计学显著关联。没有一个指标可以解释 PHAC 变化的 16%以上。对于包括所有常见病情严重程度测量指标的回归模型，学术地位是唯一与 PHAC 显著相关的变量。
ESI 与 PHAC 的关联最强，其次是 CMI 和年度 ED 量。学术地位捕捉到 ESI、CMI、年度 ED 量、医疗保险患者百分比或每位主治医生每小时就诊患者数无法解释的变异性。所有指标加起来仅解释了 PHAC 变化的 42.6%。
