Wani Rajvi Jayant, Watanabe-Galloway Shinobu, Tak Hyo Jung, Chen Li-Wu, Wehbi Nizar, Wilson Fernando
Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA
Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA.
Evid Based Ment Health. 2020 May;23(2):57-66. doi: 10.1136/ebmental-2019-300125. Epub 2020 Jan 6.
Emergency departments (EDs) have become entry points for treating behavioural health (BH) conditions, thereby rendering the evaluation of their utilisation necessary.
This study estimated behavioural-related hospital-based ED visits and outcomes of leaving against medical advice as well as the incurred charges within the primarily rural State of Nebraska. Also, the study correlated behavioural workforce distribution and location of EDs with ED utilisation.
Nebraska State Emergency Department Database provided information on utilisation of services, charges, diagnoses and demographic. Health Professional Tracking Services survey provided the distribution of EDs and BH workforce by region. To examine the effect of patient characteristics on discharge against medical advice, multivariable logistic regression modelling was used.
US$96.4 million were ED charges for 52 035 visits for BH disorders over 3 years. Of these, 35% and 50% were between 25 and 44-years old and privately insured, respectively. The uninsured (OR:1.53, p=0.0047) and 45-64 years old (OR:2.31, p<0.001) had higher odds of leaving against medical advice. The findings from this study identified ED outcomes among high-risk cohort.
There were high ED rates among the limited number EDs facilities in rural Nebraska. Rural regions of Nebraska faced workforce shortages and had high numbers of ED visits at relatively few accessible EDs.
Customised rural-centric public health programmes, which are based in clinical settings, can encourage patients to adhere to ED-treatment. Also, increasing the availability of BH workforce (either via telehealth or part-time presence) in rural areas can alleviate the problem and reduce ED revisits.
急诊科已成为治疗行为健康疾病的切入点，因此有必要对其利用率进行评估。
本研究估计了内布拉斯加州这个主要为农村地区的州内与行为相关的基于医院的急诊科就诊情况、违反医嘱离院的后果以及产生的费用。此外，该研究还将行为健康工作人员的分布和急诊科的位置与急诊科的利用率进行了关联。
内布拉斯加州急诊科数据库提供了服务利用情况、费用、诊断和人口统计学信息。卫生专业人员追踪服务调查提供了按地区划分的急诊科和行为健康工作人员的分布情况。为了研究患者特征对违反医嘱出院的影响，采用了多变量逻辑回归模型。
在3年时间里，52035次行为健康障碍就诊的急诊科费用为9640万美元。其中，分别有35%和50%的患者年龄在25至44岁之间且拥有私人保险。未参保者（比值比：1.53，p = 0.0047）和45至64岁的患者（比值比：2.31，p < 0.001）违反医嘱离院的几率更高。本研究的结果确定了高危人群中的急诊科结局。
内布拉斯加州农村地区数量有限的急诊科设施的就诊率较高。内布拉斯加州的农村地区面临劳动力短缺问题，且在相对较少的可就诊急诊科中有大量的就诊患者。
基于临床环境的以农村为中心的定制公共卫生项目可以鼓励患者坚持接受急诊科治疗。此外，增加农村地区行为健康工作人员的可及性（通过远程医疗或兼职方式）可以缓解这一问题并减少急诊科复诊。
