Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2020 Oct 27;21(6):141-145. doi: 10.5811/westjem.2020.8.48305.
The American Hospital Association (AHA) has hospital-level data, while the Centers for Medicare & Medicaid Services (CMS) has patient-level data. Merging these with other distinct databases would permit analyses of hospital-based specialties, units, or departments, and patient outcomes. One distinct database is the National Emergency Department Inventory (NEDI), which contains information about all EDs in the United States. However, a challenge with merging these databases is that NEDI lists all US EDs individually, while the AHA and CMS group some EDs by hospital network. Consolidating data for this merge may be preferential to excluding grouped EDs. Our objectives were to consolidate ED data to enable linkage with administrative datasets and to determine the effect of excluding grouped EDs on ED-level summary results.
Using the 2014 NEDI-USA database, we surveyed all New England EDs. We individually matched NEDI EDs with corresponding EDs in the AHA and CMS. A "group match" was assigned when more than one NEDI ED was matched to a single AHA or CMS facility identification number. Within each group, we consolidated individual ED data to create a single observation based on sums or weighted averages of responses as appropriate.
Of the 195 EDs in New England, 169 (87%) completed the NEDI survey. Among these, 130 (77%) EDs were individually listed in AHA and CMS, while 39 were part of groups consisting of 2-3 EDs but represented by one facility ID. Compared to the individually listed EDs, the 39 EDs included in a "group match" had a larger number of annual visits and beds, were more likely to be freestanding, and were less likely to be rural (all P<0.05). Two grouped EDs were excluded because the listed ED did not respond to the NEDI survey; the remaining 37 EDs were consolidated into 19 observations. Thus, the consolidated dataset contained 149 observations representing 171 EDs; this consolidated dataset yielded summary results that were similar to those of the 169 responding EDs.
Excluding grouped EDs would have resulted in a non-representative dataset. The original vs consolidated NEDI datasets yielded similar results and enabled linkage with large administrative datasets. This approach presents a novel opportunity to use characteristics of hospital-based specialties, units, and departments in studies of patient-level outcomes, to advance health services research.
美国医院协会（AHA）拥有医院层面的数据，而医疗保险和医疗补助服务中心（CMS）拥有患者层面的数据。将这些数据与其他独特的数据库合并，可以分析医院内的专业科室、病房或部门以及患者的治疗结果。一个独特的数据库是国家急诊部名录（NEDI），其中包含美国所有急诊部的信息。然而，合并这些数据库的一个挑战是，NEDI 单独列出了所有美国的急诊部，而 AHA 和 CMS 则按医院网络对一些急诊部进行了分组。为了进行合并，整合数据可能比排除分组的急诊部更为可取。我们的目标是整合急诊部数据，以实现与行政数据集的链接，并确定排除分组的急诊部对急诊部层面总结结果的影响。
我们使用 2014 年的 NEDI-USA 数据库调查了新英格兰的所有急诊部。我们将 NEDI 急诊部与 AHA 和 CMS 中的相应急诊部进行了单独匹配。当多个 NEDI 急诊部与单个 AHA 或 CMS 设施识别号匹配时，我们会分配一个“组匹配”。在每个组内，我们根据适当的总和或加权平均值，将单个急诊部的数据整合为一个单一的观察值。
在新英格兰的 195 个急诊部中，有 169 个（87%）完成了 NEDI 调查。其中，130 个（77%）急诊部在 AHA 和 CMS 中单独列出，而 39 个则属于由 2-3 个急诊部组成的组，但仅由一个设施 ID 代表。与单独列出的急诊部相比，包含在“组匹配”中的 39 个急诊部的年就诊人数和床位数更多，更有可能是独立的，且更不可能是农村的（所有 P<0.05）。由于列出的急诊部未回复 NEDI 调查，因此有两个分组的急诊部被排除在外；其余 37 个急诊部被合并为 19 个观察值。因此，整合数据集包含了 149 个观察值，代表了 171 个急诊部；该整合数据集得出的总结结果与 169 个回复的急诊部相似。
排除分组的急诊部会导致数据集失去代表性。原始和整合后的 NEDI 数据集得出了相似的结果，并能够与大型行政数据集进行链接。这种方法为利用医院内专业科室、病房或部门的特点来研究患者层面的治疗结果提供了一个新的机会，从而推进卫生服务研究。
