Counselman F L, Schafermeyer R W, Perina D G
Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, USA.
Acad Emerg Med. 1998 Nov;5(11):1095-100. doi: 10.1111/j.1553-2712.1998.tb02669.x.
To survey academic departments of emergency medicine (ADEMs) concerning the effects of managed care on their operation and practice.
A 38-question survey was mailed to the chairs of all 52 ADEMs in the United States requesting information concerning managed care activity and its effects on ADEMs in academic years 1994-1995 and 1995-1996.
Forty-seven ADEMs (90.3%) responded. When comparing the 1995-1996 and 1994-1995 academic years, the following changes were noted: decreased overall growth in ED patient volume (38.3% vs 51.1%), larger percentage of respondents reporting an actual decrease in ED patient volume (38% vs 27.6%), less growth in ED gross revenue (43.7% vs 52.1%), larger percentage of ADEMs reporting actual decreased gross revenues (25% vs 12.5%), increase in ED patient acuity (76.6% vs 59.6%), and relative stability in the number of EM faculty (40.4% vs 44.7% reporting no change in faculty number). Two-thirds of ADEMs used mid-level providers (i.e., physician assistants, nurse practitioners), most commonly in a fast-track setting (41%). Thirty percent of ADEMs reported that other academic departments actively directed patients away from the ED, with pediatrics, family medicine, and internal medicine the most active. Ninety-eight percent of ADEMs reported ongoing negotiations between their institution or hospital and managed care organizations (MCOs); only 54.3% of ADEMs were involved in these negotiations. Twenty-eight percent of ADEMs reported MCOs have had an effect on their emergency medical services system, with 37% indicating HMOs routinely discouraged their enrollees from using 9-1-1 services and 16% reporting HMOs provided 9-1-1 services to take patients only to participating hospital EDs.
ADEMs have experienced significant changes in nearly every aspect of their practice over the two academic years under study, much of which is due to managed care. ADEMs must take a leadership role in dealing with MCOs.
调查急诊医学学术部门（ADEMs）关于管理式医疗对其运营及实践的影响。
向美国所有52个ADEMs的负责人邮寄了一份包含38个问题的调查问卷，询问有关1994 - 1995学年和1995 - 1996学年管理式医疗活动及其对ADEMs影响的信息。
47个ADEMs（90.3%）做出了回应。比较1995 - 1996学年和1994 - 1995学年，发现以下变化：急诊室患者总量的总体增长率下降（38.3%对51.1%），报告急诊室患者总量实际下降的受访者比例更高（38%对27.6%），急诊室总收入增长较少（43.7%对52.1%），报告实际总收入下降的ADEMs比例更高（25%对12.5%），急诊室患者病情严重程度增加（76.6%对59.6%），以及急诊医学教职员工数量相对稳定（40.4%对44.7%报告教职员工数量无变化）。三分之二的ADEMs使用中级医疗人员（即医师助理、执业护士），最常见于快速通道设置（41%）。30%的ADEMs报告称其他学术部门积极引导患者远离急诊室，其中儿科、家庭医学和内科最为活跃。98%的ADEMs报告其所在机构或医院与管理式医疗组织（MCOs）正在进行谈判；只有54.3%的ADEMs参与了这些谈判。28%的ADEMs报告MCOs对其急诊医疗服务系统产生了影响，37%表示健康维护组织（HMOs）经常劝阻其参保人使用911服务，16%报告HMOs提供911服务但仅将患者送往参与的医院急诊室。
在所研究的两个学年中，ADEMs在其实践的几乎每个方面都经历了重大变化，其中大部分归因于管理式医疗。ADEMs必须在与MCOs打交道中发挥领导作用。
