Wong Andy, Johnston Amy N B, Collett Shane, Eley Robert
Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.
Ochsner J. 2022 Winter;22(4):313-318. doi: 10.31486/toj.22.0080.
Frequent presenters to emergency departments (EDs) pose many challenges around care delivery and health service management. The aim of this study was to investigate the presentation patterns of people with 5 or more ED visits in any calendar month (5+ frequent presenter [FP5+]) to develop a useful methodological framework on which the real impact of interventions may be assessed. This study is a retrospective analysis of de-identified frequent ED presentation data using segmented regression analysis of an interrupted time series (ITS). A total of 82 FP5+ to this single ED were identified in a year. Of these presenters, 77% had 10 or more presentations in a year. The total FP5+ presentations in the 12 months preceding and after each participant's ≥5 presentations in 1 month (the for inclusion in the study) accounted for 1,064 and 1,606 visits, respectively. ITS analysis of frequent ED presentations did not show a significant level change or trend change during the data collection period. Monthly review of people who frequently present to a single ED showed that presentations typically occurred in bouts that may span calendar years. Presentation bouts then typically slow, potentially distorting evaluation of the effects of interventions. Rolling monthly examination of presentation data may facilitate timely case review and care delivery, as well as provide a holistic picture of the impacts of interventions targeting patient care needs. This unique analysis demands a reconsideration of the typical before-and-after analysis of interventions for this vulnerable and high-cost group of patients.
频繁前往急诊科（ED）的患者给医疗服务提供和卫生服务管理带来了诸多挑战。本研究的目的是调查在任何日历月内有5次或更多次ED就诊的人群（5 +频繁就诊者[FP5 +]）的就诊模式，以建立一个有用的方法框架，据此可评估干预措施的实际影响。本研究是对去识别化的频繁ED就诊数据进行回顾性分析，采用中断时间序列（ITS）的分段回归分析。一年内在该单一ED中共识别出82名FP5 +患者。在这些就诊者中，77%一年中有10次或更多次就诊。在每个参与者1个月内≥5次就诊前后的12个月里（纳入研究的时间段），FP5 +的就诊总数分别为1064次和1606次。对频繁ED就诊的ITS分析在数据收集期间未显示出显著的水平变化或趋势变化。对频繁前往单一ED的人群进行月度审查发现，就诊通常呈阶段性发生，可能跨越历年。然后就诊阶段通常会放缓，这可能会扭曲对干预效果的评估。对就诊数据进行滚动月度检查可能有助于及时进行病例审查和提供医疗服务，同时也能全面了解针对患者护理需求的干预措施的影响。这种独特的分析需要重新考虑针对这一脆弱且高成本患者群体的干预措施的典型前后分析方法。
