Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand.
Acad Emerg Med. 2023 Sep;30(9):946-954. doi: 10.1111/acem.14738. Epub 2023 May 8.
Emergency department (ED) utilization is a significant concern in many countries, but few population-based studies have compared ED use. Our objective was to compare ED utilization in New York (United States), Ontario (Canada), and New Zealand (NZ).
A retrospective cross-sectional analysis of all ED visits between January 1, 2016, and September 30, 2017, for adults ≥18 years using data from the State Emergency Department and Inpatient Databases (New York), the National Ambulatory Care Reporting System and Discharge Abstract Data (Ontario), and the National Non-Admitted Patient Collection and the National Minimum Data Set (New Zealand). Outcomes included age- and sex-standardized per-capita ED utilization (overall and stratified by neighborhood income), ED disposition, and ED revisit and hospitalization within 30 days of ED discharge.
There were 10,998,371 ED visits in New York, 8,754,751 in Ontario, and 1,547,801 in New Zealand. Patients were older in Ontario (mean age 51.1 years) compared to New Zealand (50.3) and New York (48.7). Annual sex- and age-standardized per-capita ED utilization was higher in Ontario than New York or New Zealand (443.2 vs. 404.0 or 248.4 visits per 1000 population/year, respectively). In all countries, ED utilization was highest for residents of the lowest income quintile neighborhoods. The proportion of ED visits resulting in hospitalization was higher in New Zealand (34.5%) compared to New York (20.8%) and Ontario (12.8%). Thirty-day ED revisits were higher in Ontario (27.0%) than New Zealand (18.6%) or New York (21.4%).
Patterns of ED utilization differed widely across three high-income countries. These differences highlight the varying approaches that our countries take with respect to urgent visits, suggest opportunities for shared learning through international comparisons, and raise important questions about optimal approaches for all countries.
在许多国家，急诊科（ED）的使用情况令人担忧，但很少有基于人群的研究比较过 ED 的使用情况。我们的目的是比较美国纽约、加拿大安大略省和新西兰的 ED 使用情况。
这是一项回顾性的横截面分析，使用 2016 年 1 月 1 日至 2017 年 9 月 30 日期间所有年龄在 18 岁及以上的成年人在急诊就诊的数据，数据来源于州急诊和住院数据库（纽约）、国家门诊护理报告系统和出院摘要数据（安大略省）、国家非住院患者采集和国家最低数据集（新西兰）。结果包括按年龄和性别标准化的人均 ED 使用率（总体和按邻里收入分层）、ED 处置情况以及 ED 出院后 30 天内的复诊和住院情况。
纽约有 10998371 人次 ED 就诊，安大略省有 8754751 人次，新西兰有 1547801 人次。与新西兰（50.3 岁）和纽约（48.7 岁）相比，安大略省的患者年龄更大（平均年龄 51.1 岁）。按年龄和性别标准化的人均年度 ED 使用率在安大略省高于纽约或新西兰（分别为 443.2、404.0 或 248.4 次/人/年）。在所有国家，收入最低五分位数邻里的居民 ED 使用率最高。新西兰（34.5%）的住院率高于纽约（20.8%）和安大略省（12.8%）。安大略省 30 天内 ED 复诊率（27.0%）高于新西兰（18.6%）或纽约（21.4%）。
三个高收入国家的 ED 使用模式差异很大。这些差异突出了我们国家在急诊就诊方面采取的不同方法，表明通过国际比较进行共享学习的机会，并对所有国家的最佳方法提出了重要问题。
