监督住院居民对应急部门资源的使用与单独看病的医生相比
Stephen R Pitts1, Sofie R Morgan2, Justin D Schrager1
1Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
JAMA
|December 10, 2014
概括
在美国急诊室 (EDs) 监督的患者访问与增加的住院病例和先进的成像使用有关. 对于主要的教学EDs,需要对这些资源利用模式进行进一步的研究.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医学教育 医学教育
- 紧急医疗 紧急医疗
背景情况:
- 研究生医学教育通常被认为会增加医疗保健资源利用率.
- 医疗培训与急救部门 (ED) 的资源使用之间的关联存在有限的研究.
研究的目的:
- 为了比较监督 (居民和主治医生) 和仅在美国急诊部的参观者之间的资源利用情况.
- 调查ED的教学强度是否会影响监督访问期间的资源使用.
主要方法:
- 使用2010年国家医院门诊医疗调查数据进行的横截面研究.
- 定义了监督访问,并根据监督访问的比例将ED分为非教学,次要教学和主要教学.
- 分析了监督访问和住院,高级成像,血液测试和ED逗留时间之间的关联,并对共变量进行调整.
主要成果:
- 监督访问与更高的住院率 (aOR,1.42) 和高级成像使用率 (aOR,1.27) 与更长的ED停留时间 (1.32倍增加) 有关.
- 监督访问和血液检测之间没有发现显著的关联.
- 在主要的教学ED中,监督访问显示了增加入院和成像的趋势,但在统计学上没有显著意义,尽管长时间的ED停留持续了.
结论:
- 监督访问美国急诊室与增加住院,先进的成像使用和更长的ED停留时间有关.
- 这些发现表明,研究生医学教育可能有助于提高资源利用率.
- 需要进一步的调查,以了解主要教学ED的资源使用情况,居民看到大多数患者.
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