Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City 108, Taiwan.
Auditing and Advising Division, Trust Association of Republic of China, Taipei City 106, Taiwan.
Int J Environ Res Public Health. 2020 Apr 23;17(8):2914. doi: 10.3390/ijerph17082914.
Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed tomography (CT) scans, and specialist consultations (SCs). A multivariate logistic regression model was employed to analyze the impact of patient characteristics, including sex, age, income and the urbanization degree of the patient's residence; patient health status, including records of hospitalization and the number of instances of ambulatory care in the previous year; the Charlson Comorbidity Index (CCI) score; the accredited level of hospitals; and the triaged level of emergency treatments. All the patient characteristics were found to impact receiving LSI, CT and SC, except for income. Furthermore, a better health status was associated with a decreased probability of receiving LSI, CT and SC, but the number of instances of ambulatory care was not found to have a significant impact on receiving CT or SC. This study also found no evidence to support impact of CCI on SC. Hospitals with higher accredited levels were associated with a greater chance of patients receiving emergency treatments of LSI, CT and SC. A higher assigned severity (lower triaged level) led to an increased probability of receiving CT and SC. In terms of LSI, patients assigned to level 4 were found to have a lower chance of treatment than those assigned to level 5. This study found that several patient characteristics, patient health status, the accredited level of medical institutions and the triaged level, were associated with a higher likelihood of receiving emergency treatments. This study suggests that the inequality of medical resources among medical institutions with different accredited levels may yield a crowding-out effect.
急诊医生决定的紧急治疗方法可能会影响死亡率和患者满意度。本文试图探讨患者特征、健康状况、医院认证级别和分诊级别对以下紧急治疗方法的影响:立即救生干预(LSI)、计算机断层扫描(CT)和专科咨询(SC)。采用多变量逻辑回归模型分析了患者特征(包括性别、年龄、收入和患者居住地的城市化程度)、患者健康状况(包括住院记录和前一年的门诊就诊次数)、Charlson 合并症指数(CCI)评分、医院认证级别和紧急治疗的分诊级别对接受 LSI、CT 和 SC 的影响。除收入外,所有患者特征均影响接受 LSI、CT 和 SC。此外,健康状况较好的患者接受 LSI、CT 和 SC 的可能性降低,但门诊就诊次数对接受 CT 或 SC 没有显著影响。本研究也没有证据表明 CCI 对 SC 有影响。认证级别较高的医院与患者接受 LSI、CT 和 SC 的可能性更大有关。严重程度较高(较低的分诊级别)导致接受 CT 和 SC 的可能性增加。就 LSI 而言,被分配到 4 级的患者接受治疗的机会低于被分配到 5 级的患者。本研究发现,一些患者特征、患者健康状况、医疗机构认证级别和分诊级别与接受紧急治疗的可能性增加有关。本研究表明,不同认证级别医疗机构之间的医疗资源不平等可能产生排挤效应。