Wahlster Philip, Czihal Thomas, Gibis Bernhard, Henschke Cornelia
Zentrum Allgemeinmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg (Saar).
Versorgungsforschung und Risikostruktur, Zentralinstitut für die kassenärztliche Versorgung, Berlin.
Gesundheitswesen. 2020 Jun;82(6):548-558. doi: 10.1055/a-0820-3904. Epub 2019 Feb 20.
Increasing numbers of emergency cases, different stakeholders involved (physicians' practices vs. hospitals providing ambulatory and inpatient care) and changing patient utilization patterns lead to changes in health care needs. This study aimed at analyzing changes in patient characteristics as well as indications for in- and outpatient emergency care between 2009 and 2015 and their potential reasons.
Based on in- and outpatient routine data, we descriptively analyzed changes in emergency diagnosis, population-based emergency prevalence as well as regional differences and their changes over time. Using generalized linear models (GLM), we examined regional shifts in emergency cases being treated in ambulatory and inpatient settings.
Between 2009 and 2014 the number of cross-sectoral ambulatory emergency cases increased by 4 % (in emergency departments an increase by 42% with the highest incidence rate ratio (IRR) in the 20-34-year-old age group). Inpatient emergency cases increased by 20% with older patients representing the largest group. The ICD chapter "Diseases of the circulatory system", responsible for most inpatient hospital cases, had the second highest probability of hospital addmissions (64.7%). There were larger variations in indications for outpatient care. Regression analysis showed that there was greater use of ambulatory emergency services by the healthier (IRR 1.15 [KI 95%: 1.13; 1.16]) and urban population (IRR 1.14 [KI 95%: 1.13; 1.15]).
The first time cross-sector analysis of indication-specific emergencies based on nationwide inpatient and outpatient billing data from 2009-2015 provides insightsinto healthcare provision at the interface between the sectors. Indications that are treated in physician practices and emergency outpatient clinics and those that lead to hospital admissions point out the potential for managing patient care appropriately. Patient behaviors in healthcare utilization can be addressed by interventions for specific patient subgroups. However, a prerequisite for the development of such measures is the inclusion of a cross-sectoral perspective in the system of emergency care.
急诊病例数量不断增加，涉及不同利益相关者（医生诊所与提供门诊和住院治疗的医院）以及患者使用模式的变化导致医疗保健需求发生改变。本研究旨在分析2009年至2015年间患者特征的变化以及门诊和住院急诊护理的指征及其潜在原因。
基于门诊和住院常规数据，我们对急诊诊断、基于人群的急诊患病率以及地区差异及其随时间的变化进行了描述性分析。使用广义线性模型（GLM），我们研究了门诊和住院环境中急诊病例的地区转移情况。
2009年至2014年间，跨部门门诊急诊病例数量增加了4%（急诊部门增加了42%，20至34岁年龄组的发病率最高）。住院急诊病例增加了20%，老年患者占最大群体。导致大多数住院病例的国际疾病分类（ICD）章节“循环系统疾病”的住院概率第二高（64.7%）。门诊护理指征的差异更大。回归分析表明，健康人群（发病率比值比[IRR]为1.15[95%置信区间：1.13；1.16]）和城市人群（IRR为1.14[95%置信区间：1.13；1.15]）对门诊急诊服务的使用更多。
首次基于2009 - 2015年全国住院和门诊计费数据对特定指征急诊进行跨部门分析，为跨部门医疗保健提供提供了见解。在医生诊所和急诊门诊治疗的指征以及导致住院的指征指出了合理管理患者护理的潜力。针对特定患者亚组的干预措施可以解决患者在医疗保健利用方面的行为问题。然而，制定此类措施的一个先决条件是在急诊护理系统中纳入跨部门视角。
