MacKoul D, Feldman M, Savageau J, Krumholz A
Department of Medicine, University of Massachusetts Medical Center, Worcester, USA.
Am J Med Qual. 1995 Summer;10(2):88-92. doi: 10.1177/0885713X9501000205.
The effect of a triage and care system, which employs continued patient education, alternatives to emergency department (ED) care for nonemergent problems, and close cooperation between ED staff and the primary care physician on inappropriate ED use, was analyzed for three groups of patients: (a) Medicaid patients, all of whom had unrestricted access to the ED; (b) group A patients who required prior physician approval and copayments for all ED services; and (c) patients enrolled in group B who were responsible for copayments only and did not require prior physician approval for ED use. Two hundred ninety-nine (299) charts were prospectively reviewed for age, payer status, date, time of visit, diagnosis, outcome of visit, and severity of illness. Medicaid patients utilized the ED much more than expected, compared to either group A or B patients (P < 0.001). Expected rates of utilization were based upon that particular group's representation in a medical associate's patient panel, which was based upon patient billing data. Medicaid patients were significantly younger than group A or B patients (P < 0.001) and had lower severity scores (P = 0.04). Our triage and care system failed to alter patterns of ED utilization for Medicaid patients.
分析了一种分诊与护理系统对三组患者不适当使用急诊科情况的影响，该系统采用持续的患者教育、针对非紧急问题的急诊科护理替代方案以及急诊科工作人员与初级保健医生之间的密切合作。这三组患者分别为：(a) 医疗补助患者，他们均可无限制地使用急诊科；(b) A组患者，他们使用所有急诊科服务均需事先获得医生批准并支付共付费用；(c) 参加B组的患者，他们仅需支付共付费用，使用急诊科无需事先获得医生批准。前瞻性地查阅了299份病历，以了解年龄、付款人状况、日期、就诊时间、诊断、就诊结果和疾病严重程度。与A组或B组患者相比，医疗补助患者使用急诊科的频率远远高于预期（P < 0.001）。预期使用率是根据该特定组在医疗合作伙伴患者样本中的占比得出的，而该样本是基于患者计费数据。医疗补助患者明显比A组或B组患者年轻（P < 0.001），且严重程度评分较低（P = 0.04）。我们的分诊与护理系统未能改变医疗补助患者使用急诊科的模式。
