老年频繁急诊科使用者的服务利用情况：一项回顾性队列研究。

Service use by older very frequent emergency department users: A retrospective cohort study.

作者信息

Berry D, Street M, Considine J

机构信息

School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University - Eastern Health Partnership, Box Hill, Australia.

School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University - Eastern Health Partnership, Box Hill, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia.

出版信息

Australas Emerg Care. 2019 Sep;22(3):133-138. doi: 10.1016/j.auec.2019.05.001. Epub 2019 Jun 10.

DOI:10.1016/j.auec.2019.05.001

PMID:31196735

Abstract

BACKGROUND

Frequent Emergency Department (ED) attendance is a common occurrence, across all patient age groups. Older frequent users of ED are an at-risk group who often have complex, chronic health needs with many requiring out-of-hospital services to support their care. The aim of this study is to identify the characteristics, outcomes and health service use of older, very frequent emergency department (ED) users.

METHODS

A retrospective cohort study, at three Australian EDs, comparing first and last ED attendances, by older people (≥65 years) with frequent ED use (≥8 attendances/year).

RESULTS

There were 1387 ED attendances in 12 months by 115 patients (median=11). The median age-adjusted Charlson comorbidity score increased between attendances (5 vs 6, p<0.001). From first to last visit, hospital stays exceeding 7 days increased (12% vs 20%, p=0.013), while both ED re-attendances within 28 days (58% vs 20%, p≤0.001) and hospital readmissions within 30 days (39% vs 23%, p=0.016) decreased. In-patient mortality was 11% (n=10/88). There was no change in out-of-hospital services in place at both ED attendances (55% vs 61%, p=0.185).

CONCLUSIONS

Out-of-hospital service use did not change despite frequent ED attendance. Older very frequent ED users had increasing co-morbidities over time and often required hospital admission.

摘要

背景

在所有患者年龄组中，频繁前往急诊科就诊是一种常见现象。老年急诊频繁使用者是一个高危群体，他们通常有复杂的慢性健康需求，许多人需要院外服务来支持其护理。本研究的目的是确定老年急诊频繁使用者的特征、结局和卫生服务利用情况。

方法

在澳大利亚的三家急诊科进行一项回顾性队列研究，比较≥65岁且急诊就诊频繁（≥8次/年）的老年人首次和最后一次急诊就诊情况。

结果

115名患者在12个月内急诊就诊1387次（中位数 = 11次）。就诊期间年龄调整后的Charlson合并症评分中位数有所增加（5分对6分，p<0.001）。从首次就诊到最后一次就诊，住院时间超过7天的情况增加（12%对20%，p = 0.013），而28天内的急诊再就诊率（58%对20%，p≤0.001）和30天内的医院再入院率（39%对23%，p = 0.016）均下降。住院死亡率为11%（n = 10/88）。两次急诊就诊时的院外服务情况没有变化（55%对61%，p = 0.185）。