美国急诊部医生助理的使用情况；2010 年至 2017 年。

Physician assistant utilization in U.S. emergency departments; 2010 to 2017.

机构信息

Department of Emergency Medicine, University of California San Francisco (UCSF), Fresno, United States of America.

出版信息

Am J Emerg Med. 2021 Apr;42:132-136. doi: 10.1016/j.ajem.2020.02.009. Epub 2020 Feb 10.

DOI:10.1016/j.ajem.2020.02.009

PMID:32067840

Abstract

BACKGROUND

Physician Assistants (PAs) are widely used in United States (US) Emergency Departments (EDs). We sought to characterize ED PA utilization and practice characteristics in US EDs 2010-2017.

METHODS

A retrospective, secondary analysis of the 2010 to 2017 Center for Disease Control's National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed. National estimates of ED visits involving PAs alone (PA), PAs with physician involvement (PA+), or physician only (PHYS) were analyzed for patient demographics and hospital characteristics.

RESULTS

Between 2010 and 2017, an estimated 1 billion US ED visits occurred. 5.0% (95% confidence interval [CI] ±2.7%) of visits were seen by a PA, and 8.2% (±2.7%) by a PA+; 76.3% (±7.2%) by PHYS. No linear trends by year were identified in PA or PA+ visits. PA acuity was highest for semi-urgent/nonurgent (56.4%, ±10.7%). PA see the minority of ambulance arrival [5.8% (±1.3)] and admit less patients [1.7% (±0.7%)]. Less laboratory [53.3% (±10.2%) vs. 67.0% (±6.2%)] and radiographic [38.8% (±6.6%) vs. 51.6% (±4.6%) studies were performed during PA vs. PHYS visits. PA visits were most common for patients 25-44 years old (yo) (32.9%, ±6.2%) and 15-24 yo (19.2%, ±3.7%). Most PA visits result in a length of stay (LOS) between 1 and 1.9 h (32.9%, ±6.7%) compared to most PHYS visits resulting in a LOS >3 h (40.3%, ±3%).

CONCLUSIONS

From 2010 to 2017, no linear trends in US ED PA and PA+ utilization were identified. PHYS continue to see the majority of ED patients.

摘要

背景

医师助理（PA）在美国（美国）急诊部（ED）中被广泛使用。我们旨在描述 2010 年至 2017 年美国 ED 中 ED PA 的利用情况和实践特征。

方法

对 2010 年至 2017 年疾病控制中心国家医院门诊医疗调查（NHAMCS）进行回顾性二次分析。对仅涉及 PA（PA），PA 与医生一起参与（PA+）或仅医生（PHYS）的 ED 就诊的患者人口统计学和医院特征进行国家估计。

结果

在 2010 年至 2017 年间，估计有 10 亿美国 ED 就诊。5.0％（95％置信区间[CI] ±2.7％）的就诊由 PA 就诊，8.2％（±2.7％）由 PA+就诊；76.3％（±7.2％）由 PHYS 就诊。未发现 PA 或 PA+就诊的年度线性趋势。PA 的急症程度最高，为半紧急/非紧急（56.4％，±10.7％）。PA 仅看到少数救护车到达[5.8％（±1.3）]，并且住院患者较少[1.7％（±0.7％）]。实验室检查较少[53.3％（±10.2％）与 67.0％（±6.2％）]和放射照相检查[38.8％（±6.6％）与 51.6％（±4.6％）]在 PA 与 PHYS 就诊期间进行。PA 就诊最常见于 25-44 岁（yo）的患者（32.9％，±6.2％）和 15-24 岁的患者（19.2％，±3.7％）。与大多数 PHYS 就诊导致 LOS > 3 小时（40.3％，±3％）相比，大多数 PA 就诊导致 1 至 1.9 小时的 LOS（32.9％，±6.7％）。