退伍军人事务急诊科常见疾病住院实践的临床水平差异

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE
Alexander T Janke, Aaron Dalton, Keith E Kocher, Anita A Vashi
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引用次数: 0

摘要

背景:退伍军人事务(VA)医疗保健系统寻求提高护理的价值。住院实践的变化可能是提高急诊护理效率和质量的一个目标。方法:对2015年10月1日至2023年6月8日的113个VA急诊科(EDs)进行回顾性横断面分析。在先前开发的入院强度测量中,如果患者的初步诊断符合535个ICD-10代码中的一个,则纳入ED就诊,其中包括16种已知入院实践变化和门诊管理机会的临床情况。主要结局是临床水平的标准偏差(SD),每种疾病的风险调整入院率,使用考虑患者社会人口统计学和临床特征的多层次分层模型计算。然后,我们总结了临床医生入院率的SD,基于VA的总入院量。我们进一步评估了临床医生入院强度与72小时ED复诊导致住院(一个安全指标)之间的关系,使用Pearson相关系数。结果:在研究期间,9350名临床医生记录了1850万次急诊科就诊,其中3,815,094次就诊(20.6%)的初步诊断符合入院强度测量中包含的16种临床条件之一。患者平均(±SD)年龄为63.3岁(SD 15.4)岁,男性占89.9%。在16种疾病中,胸痛占入院人数最多(229,507),临床水平入院率变化最大(SD±14.7%),而肾结石变化最小(SD±4.6%)。入院率与72小时ED复发无显著相关性(Pearson相关系数为0.018)。结论:先前开发的住院强度测量可能有助于确定VA急诊科住院实践的改进机会。胸痛是测量中最常见的情况,并且在临床医生的入院实践中受到最大的变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinician-level variation in admission practices for common conditions in Veteran Affairs emergency departments.

Background: The Veterans Affairs (VA) Healthcare System seeks to improve value of care. Variations in hospital admission practices may be a target to improve the efficiency and quality of emergency care.

Method: This was a retrospective cross-sectional analysis of 113 VA emergency departments (EDs) from October 1, 2015 to June 8, 2023. ED visits were included if their primary diagnosis matched one of 535 ICD-10 codes within the previously developed admission intensity measure, encompassing 16 clinical conditions with known variation in admission practices and opportunities for outpatient management. The primary outcome was the standard deviation (SD) of clinician-level, risk-adjusted admission rates for each condition, calculated using multilevel, hierarchical models accounting for patient sociodemographic and clinical characteristics. We then summarized the SD of clinician admission rates, based on total admission volume at VA. We further assessed the association between clinician admission intensity and 72-h ED return visits resulting in hospitalization, a safety indicator, using Pearson correlation coefficients.

Results: During the study period, 18.5 million ED visits were recorded across 9350 clinicians, with 3,815,094 visits (20.6%) having primary diagnoses matching one of the 16 clinical conditions included in the admission intensity measure. Patients' mean (±SD) age was 63.3 (SD 15.4) years, and 89.9% were male. Among the 16 conditions, chest pain accounted for the highest number of admissions (229,507) and exhibited the greatest variation (SD ±14.7%) in clinician-level admission rates, while nephrolithiasis had the lowest variation (SD ±4.6%). There was no significant association between clinician admission rates and 72-h ED returns (Pearson correlation 0.018).

Conclusion: A previously developed admission intensity measure may help identify improvement opportunities in hospitalization practices across VA EDs. Chest pain was the most common condition among those in the measure, and subject to the most variability in admission practices among clinicians.

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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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