PA-20-070 Identifying Predictors of Hospital Admission from the ED Among the Elderly

PA-20-070 确定老年人急诊室入院的预测因素

• 批准号: 10175813
• 负责人: Bruce E. Landon
• 金额: $ 39.88万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175813
• 关键词: PA; 20; 070; Identifying; Predictors

Project Summary: The ongoing COVID-19 pandemic has had a dramatic impact on emergency care. Reports from around the country suggest that ED visits for non-COVID related conditions such as acute myocardial infarction and stroke have plummeted by 30-50%, and anecdotal data suggests that overall visit volume for non-COVID related conditions has also decreased. Conditional on presenting to the ED, the pandemic also is changing how ED providers approach the decision to admit a patient to the hospital. There may be a number of motivations involved in this decision-making, some related to system-level factors such as capacity constraints and some related to changes in assessments of the risks and benefits of hospitalization for individual patients. The emergency department (ED) is the primary source for hospital admissions in the US. Over 70% of hospital admissions among Medicare patients originate from the ED at an extraordinary cost to Medicare.1 Rates of hospital admission from the ED vary widely across regions, hospitals, and even across physicians within hospitals. A critical need exists to determine the extent to which factors related to the COVID-19 pandemic have altered provider decision-making in the ED and whether these decisions are associated with greater harm for patients. Lessons learned from these analyses will be vital to guiding ED providers in approaching the decision to admit during future phases of this pandemic as well as under similar circumstances that might arise. Moreover, there is a possibility that for some non-COVID related conditions hospitalization rates pre-COVID-19 were too high (low-value admissions), and that admission rates are now more optimal. Thus, there could be longer term improvements in the efficiency of the health care delivery system that can be gained by optimizing the use of inpatient hospital care, its most expensive component. The proposed study will utilize data on Medicare beneficiaries and their care providers to accomplish three key aims. Using nationally representative data from the Medicare program aim 1 will examine the extent to which the COVID-19 pandemic has impacted ED visit rates for specific diagnoses in parts of the country more and less effected by the pandemic. The second aim will then examine how admission decisions from the ED have been impacted. Finally, aim 3 will examine the impact of changes in admission on patient outcomes including 30-day mortality and ED revisits. The second and third aims will use rigorous quasi-experimental methods to compare changes in the outcomes of interest in areas of the country more and less impacted by the COVID-19 pandemic. Our central hypotheses are that the rate of admission will be decreased (across a broad array of non-COVID-19 related conditions) during the time of the pandemic, that greater decreases in admission will be seen for areas that were particularly impacted by COVID-19, and that these decreases in admission rates will be associated with worse clinical outcomes.

项目摘要： 持续的共同19日大流行对急诊护理产生了巨大影响。来自周围的报告 该国建议，ED访问非卵路相关条件，例如急性心肌梗塞和 中风跌幅下降了30-50％，轶事数据表明，非循环的总访问量 相关条件也有所下降。有条件向ED展示，大流行也在改变 ED提供者如何决定将患者送往医院。可能有很多 这种决策涉及的动机，一些与系统级因素有关的动机，例如容量限制 以及一些与单个患者对住院风险和益处的评估变化有关的。 急诊科（ED）是美国入院的主要来源。超过70％ Medicare患者的住院入院起源于ED，以非凡的成本为基础。1 ED的住院率在各个地区，医院，甚至在医师之间的差异很大 在医院内。存在关键需求，以确定与COVID-19的因素的程度 大流行改变了急诊室的提供者决策，以及这些决定是否与 对患者的伤害更大。从这些分析中学到的经验教训对于指导ED提供商至关重要 做出决定在这个大流行的未来阶段以及在类似阶段的决定 可能出现的情况。此外，对于某些非卵路相关条件有可能 199年前的住院率太高（低价值入院），现在入院率是 更最佳。因此，医疗保健提供的效率可能会有所提高 可以通过优化使用住院医院护理（其最昂贵的组件）来获得的系统。 拟议的研究将利用有关医疗保险受益人及其护理提供者的数据来完成三个 关键目标。使用Medicare计划AIM 1的全国代表性数据1将检查 COVID-19的大流行对该国部分地区的特定诊断影响了ED访问率更多 而且大流行的影响较小。然后，第二个目标将研究急诊室的承认决策 受到了影响。最后，AIM 3将检查入院变化对患者预后的影响 包括30天死亡率和ED重新审视。第二和第三目标将使用严格的准实验 比较该国在该国地区感兴趣的结果的变化的方法。 19009年大流行。我们的中心假设是入院率将降低（在 在大流行时期 对于特别受Vovid-19的特别影响的地区，将看到入院 入院率将与较差的临床结果有关。

项目成果

Weak correlations in health services research: Weak relationships or common error?

卫生服务研究中的弱相关性：弱关系还是常见错误？

• DOI: 10.1111/1475-6773.13882
• 发表时间: 2022
• 期刊: Health services research
• 影响因子: 3.4
• 作者: O'Malley,AlistairJames;Landon,BruceE;Zaborski,LawrenceA;Roberts,EricT;Khidir,HazarH;Smulowitz,PeterB;McWilliams,JohnMichael
• 通讯作者: McWilliams,JohnMichael

Association of Functional Status, Cognition, Social Support, and Geriatric Syndrome With Admission From the Emergency Department.

功能状态、认知、社会支持和老年综合症与急诊科入院的关联。

• DOI: 10.1001/jamainternmed.2023.2149
• 发表时间: 2023
• 期刊: JAMA internal medicine
• 影响因子: 39
• 作者: Smulowitz,PeterB;Weinreb,Gabe;McWilliams,JMichael;O'Malley,AJames;Landon,BruceE
• 通讯作者: Landon,BruceE

Variation In Emergency Department Admission Rates Among Medicare Patients: Does The Physician Matter?

• DOI: 10.1377/hlthaff.2020.00670
• 发表时间: 2021-02-01
• 期刊: HEALTH AFFAIRS
• 影响因子: 9.7
• 作者: Smulowitz, Peter B.;O'Malley, A. James;Landon, Bruce E.
• 通讯作者: Landon, Bruce E.