Huang Dih-Dih, Shehada Mahmoud Z, Chapple Kristina M, Rubalcava Nathaniel S, Dameworth Jonathan L, Goslar Pamela W, Israr Sharjeel, Petersen Scott R, Weinberg Jordan A
Department of Surgery, Dignity Health, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Trauma Surg Acute Care Open. 2019 Jan 12;4(1):e000239. doi: 10.1136/tsaco-2018-000239. eCollection 2019.
Emergency department (ED) visits after hospital discharge may reflect failure of transition of care to the outpatient setting. Reduction of postdischarge ED utilization represents an opportunity for quality improvement and cost reduction. The Community Need Index (CNI) is a Zip code-based score that accounts for a community's unmet needs with respect to healthcare and is publicly accessible via the internet. The purpose of this study was to determine if patient CNI score is associated with postdischarge ED utilization among hospitalized trauma patients.
Level 1 trauma patient admitted between January 2014 and June 2016 were stratified by 30-day postdischarge ED utilization (yes/no). CNI is a nationwide Zip code-based score (1.0-5.0) and was determined per patient from the CNI website. Higher scores indicate greater barriers to healthcare per aggregate socioeconomic factors. Patients with 30-day postdischarge ED visits were compared with those without, evaluating for differences in CNI score and clinical and demographic characteristics.
309 of 3245 patients (9.5%) used the ED. The ED utilization group was older (38.3±15.7 vs. 36.3±16.4 years, p=0.034), more injured (Injury Severity Score 10.4±8.7 vs. 7.7±8.0, p<0.001), and more likely to have had in-hospital complications (17.5% vs. 5.4%, p<0.001). Adjusted for patient age, injury severity, gender, race/ethnicity, penetrating versus blunt injury, alcohol above the legal limit, illicit drug use, the presence of one or more complications and comorbidities, hospital length of stay, and insurance category, CNI score ≥4 was associated with increased utilization (OR 2.0 [95% CI 1.4 to 2.9, p<0.001]).
CNI is an easily accessible score that independently predicts postdischarge ED utilization in trauma patients. Patients with CNI score ≥4 are at significantly increased risk. Targeted intervention concerning discharge planning for these patients represents an opportunity to decrease postdischarge ED utilization.
III, Prognostic and Epidemiological.
出院后到急诊科就诊可能反映了向门诊环境的护理过渡失败。减少出院后急诊科的利用率是提高质量和降低成本的一个机会。社区需求指数（CNI）是一种基于邮政编码的评分，它考虑了社区在医疗保健方面未得到满足的需求，并且可以通过互联网公开获取。本研究的目的是确定患者的CNI评分是否与住院创伤患者出院后急诊科的利用率相关。
对2014年1月至2016年6月期间收治的1级创伤患者，根据出院后30天内是否到急诊科就诊（是/否）进行分层。CNI是一个基于全国邮政编码的评分（1.0 - 5.0），可通过CNI网站为每位患者确定。较高的分数表明总体社会经济因素导致的医疗保健障碍更大。将出院后30天内到急诊科就诊的患者与未就诊的患者进行比较，评估CNI评分以及临床和人口统计学特征的差异。
3245例患者中有309例（9.5%）使用了急诊科。急诊科利用率较高的组患者年龄更大（38.3±15.7岁对36.3±16.4岁，p = 0.034），受伤更严重（损伤严重度评分10.4±8.7对7.7±8.0，p < 0.001），并且更有可能出现住院并发症（17.5%对5.4%，p < 0.001）。在对患者年龄、损伤严重程度、性别、种族/族裔、穿透伤与钝器伤、酒精含量超过法定限量、非法药物使用、是否存在一种或多种并发症和合并症、住院时间以及保险类别进行调整后，CNI评分≥4与利用率增加相关（比值比2.0 [95%可信区间1.4至2.9，p < 0.001]）。
CNI是一个易于获取的评分，可独立预测创伤患者出院后急诊科的利用率。CNI评分≥4的患者风险显著增加。针对这些患者的出院计划进行有针对性的干预是降低出院后急诊科利用率的一个机会。
III，预后和流行病学。
