Western Carolina University, 4121 Little Savannah Rd, Cullowhee, NC 28723, United States of America.
Am J Emerg Med. 2019 Jun;37(6):1096-1100. doi: 10.1016/j.ajem.2018.08.068. Epub 2018 Aug 29.
To determine whether ambulance arrival to the emergency department has remained an unidentified signal of perceived medical acuity. Informed by economic signaling theory, does arrival via ambulance affect resource utilization given varying levels of patient acuity?
The analysis examined a nationally representative sample of de-identified emergency department patient encounters from 2011 to 2015, gathered from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Multivariate logistic regression analysis was employed using regional and time-fixed effects. The provision of twenty diagnostic and imaging services was analyzed. Patient encounters were also categorized into five acuity-levels.
Drawing from the NHAMCS dataset, 98,888 emergency department records were analyzed, weighted to represent 504.5 million estimated emergency department patient encounters. Findings suggest that patients transported to the hospital via ambulance are more likely than those who arrive by other means to receive 19 of the 20 analyzed diagnostic testing and imaging services. Furthermore, when analyzed by acuity-level, the disparity of service provision is the greatest among low-acuity patients, where medical complaints are argued to be the most subjective.
The results are consistent with the notion that emergency department medical providers readily accept ambulance transport as a valid signal of patient acuity, regardless of true acuity level. Consequently, patients transported to the hospital via ambulance may be receiving a disproportionate amount of medical resources in an increasingly cost-conscious environment.
确定救护车到达急诊科是否仍然是感知医疗紧迫性的未识别信号。根据经济信号理论，在患者严重程度不同的情况下，通过救护车到达是否会影响资源利用？
该分析使用来自国家医院门诊医疗保健调查（NHAMCS）的 2011 年至 2015 年期间的全国代表性急诊患者就诊的匿名数据，采用区域和时间固定效应的多变量逻辑回归分析。分析了二十种诊断和成像服务的提供情况。还将患者就诊分为五个严重程度级别。
从 NHAMCS 数据集分析了 98888 份急诊科记录，加权后代表了 5.045 亿次估计的急诊科患者就诊。研究结果表明，与通过其他方式到达医院的患者相比，通过救护车送往医院的患者更有可能接受分析的 20 项诊断测试和成像服务中的 19 项。此外，按严重程度级别进行分析时，在低严重程度患者中，服务提供的差异最大，而医疗投诉被认为是最主观的。
这些结果与以下观点一致，即急诊医疗提供者很容易接受救护车转运作为患者严重程度的有效信号，而不管实际严重程度如何。因此，在成本意识日益增强的环境中，通过救护车送往医院的患者可能会获得不成比例的医疗资源。
