Department of Emergency Medicine, Philadelphia, PA.
Department of Family and Community Medicine, Philadelphia, PA.
Acad Emerg Med. 2019 May;26(5):501-509. doi: 10.1111/acem.13621. Epub 2018 Oct 30.
The objective was to examine the relationship between patient uncertainty at the time of emergency department (ED) discharge as measured by the "Uncertainty Scale" (U-Scale) and 30-day return ED visits. We hypothesized that a higher score on the U-Scale predicts a higher likelihood of a 30-day return ED visit.
This was a cross-sectional single-site pilot study performed with adult patients discharged from an urban academic ED to assess the relationship of U-Scale total and subscale scores with 30-day return ED visits. We collected demographic and U-Scale scores at the time of ED discharge and subsequent 30-day ED utilization data by follow-up telephone call.
No association was found between the total U-Scale score and subsequent ED utilization. Patients with higher uncertainty on the Treatment Quality subscale of the U-Scale had higher odds of a 30-day return ED visit (adjusted odds ratio [AOR] = 1.16), while patients with lower uncertainty on the Decision to Seek Care subscale had higher odds of a 30-day return ED visit (AOR = 0.68).
Patient uncertainty as measured by the U-Scale total score was not predictive of subsequent ED utilization. However, uncertainty related to treatment quality and the decision to seek care as measured by the U-Scale subscales may be important in predicting repeat ED utilization. Unlike individual patient factors such as age and race that have been associated with frequent ED visits in prior studies, these domains of uncertainty are potentially modifiable. Providers and health systems may successfully prevent recurrent acute care encounters through implementation of interventions designed to address patient uncertainty. Further work is needed to refine the U-Scale and test its predictive utility among a larger patient cohort.
本研究旨在通过“不确定量表”（U-Scale）评估急诊科（ED）出院时患者的不确定性，并探讨其与 30 天内重返 ED 的关系。我们假设 U-Scale 得分越高，患者在 30 天内重返 ED 的可能性越大。
这是一项在城市学术 ED 出院的成年患者中进行的横断面单站点试点研究，旨在评估 U-Scale 总分和子量表评分与 30 天内重返 ED 的关系。我们在 ED 出院时收集了人口统计学和 U-Scale 评分，并通过随访电话收集了后续 30 天内 ED 利用数据。
U-Scale 总分与随后的 ED 利用之间未发现关联。在 U-Scale 治疗质量子量表上不确定性较高的患者，30 天内重返 ED 的可能性更高（调整后的优势比 [AOR] = 1.16），而在寻求治疗决策子量表上不确定性较低的患者，30 天内重返 ED 的可能性更高（AOR = 0.68）。
U-Scale 总分所测量的患者不确定性与随后的 ED 利用无关。然而，U-Scale 子量表所测量的与治疗质量和寻求治疗决策相关的不确定性可能是预测重复 ED 利用的重要因素。与先前研究中与频繁 ED 就诊相关的个体患者因素（如年龄和种族）不同，这些不确定性领域是潜在可改变的。通过实施旨在解决患者不确定性的干预措施，提供者和医疗系统可以成功预防再次发生急性护理事件。需要进一步的工作来完善 U-Scale，并在更大的患者队列中测试其预测实用性。
