Abstract:
INTRODUCTION:Emergency department (ED) utilization represents an expensive and growing means of accessing care for a variety of conditions. Prior studies have characterized ED utilization in the general population. We aim to identify the clinical conditions that drive ED utilization in a universally insured population and the impacts of care setting on ED use and admissions in the U.S. Military Health System. METHODS:We queried TRICARE claims data from October 1, 2012, to September 30, 2015, to identify all ED visits for adult patients (age 18-64). The primary presenting diagnoses of all ED visits and those leading to admission are presented with descriptive statistics. Logistic regression was used to identify clinical and sociodemographic factors associated with admission from the ED. RESULTS:A total of 4,687,205 ED visits were identified, of which 46% took place in the DoD healthcare facilities (direct care). The most common diagnoses across all ED visits were abdominal pain, chest pain, headache, nausea and vomiting, and urinary tract infection. A total of 270,127 (5.8%) ED visits led to inpatient admission. The most common diagnoses leading to admission were chest pain, abdominal pain, depression, conditions relating to acute psychological stress, and pneumonia. For patients presenting with 1 of the 10 most common ED diagnoses, those who were seen at a civilian ED were significantly less likely to be admitted (3.4%) compared to direct care facilities (4.1%) in an adjusted logistic regression model (Adjusted Odds Ratio 0.40 [95% CI: 0.40-0.41], P < .001). CONCLUSIONS:Ultimately, we show that abdominal pain and chest pain are the most common reasons for presentation to the ED in the Military Health System and the most common presenting diagnoses for admission from the ED. Among patients presenting with the most common ED conditions, direct care EDs were significantly more likely to admit patients than civilian facilities.
journal_name
Mil Medjournal_title
Military medicineauthors
Dalton MK,Andriotti T,Matsas B,Chaudhary MA,Tilley L,Lipsitz S,Learn PA,Schoenfeld AJ,Jarman MP,Goralnick Edoi
10.1093/milmed/usaa547subject
Has Abstractpub_date
2020-12-17 00:00:00eissn
0026-4075issn
1930-613Xpii
6040599pub_type
杂志文章abstract::Smoking prevention and cessation programs were implemented and evaluated in recruit training. Four groups of incoming recruits were compared: an education group, a no-smoking group, a health risk appraisal feedback group, and a no-treatment control group. Smoking behavior, perceptions related to smoking, and knowledge...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1989-07-01 00:00:00
abstract::This study examined the impact of a history of childhood abuse and neglect on soldiers' adaptation to Army life including commitment to the Army, confidence in leaders, and perceptions of unit cohesion and readiness. Childhood abuse and neglect were measured by the 30-item Childhood Trauma Questionnaire (CTQ) which co...
journal_title:Military medicine
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更新日期:1996-11-01 00:00:00
abstract::To help preserve in-theater strength within deployed military units, commercially available, rapid, user-friendly ABO-Rh blood typing kits were evaluated to determine their stability in storage conditions commonly encountered by the warfighter. Methods for environmental exposure testing were based on MIL-STD-810F. Whe...
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journal_title:Military medicine
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doi:
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abstract::The purpose of this study was to evaluate the effects of the M17 and M43 protective masks on stereoacuity. Twelve subjects were tested on the Keystone diagnostic series stereopsis test at nearpoint and the Howard-Dolman apparatus at 40 cm and 6 m. Stereopsis was evaluated without a mask and with the M43 and M17 masks....
journal_title:Military medicine
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doi:
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abstract::Damage to the lymphatic vessels may occur after surgery on the greater saphenous vein. We describe the development of a lymphocele in a patient after saphenous vein harvesting for a coronary artery bypass graft. Treatment of these lymphoceles should initially be conservative, but if this approach fails, surgical excis...
journal_title:Military medicine
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doi:
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abstract:BACKGROUND:The liver stages of Plasmodium parasites are important targets for the discovery and development of prophylactic drugs. METHODS:A real-time in vivo imaging system was used to determine the level of luminescence measured from firefly luciferase expression by sporozoites developing in hepatocytes in different...
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pub_type: 杂志文章,随机对照试验
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journal_title:Military medicine
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journal_title:Military medicine
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doi:
更新日期:1999-07-01 00:00:00
abstract::During Operation Assured Response in Liberia and Sierra Leone, between May and July 1996, five confirmed cases of falciparum malaria occurred in U.S. Navy personnel. The threat of malaria in west central Africa was recognized from the outset, and preventive medicine guidance was given to all the units participating in...
journal_title:Military medicine
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doi:
更新日期:1997-12-01 00:00:00
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journal_title:Military medicine
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doi:
更新日期:1998-07-01 00:00:00
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更新日期:2012-04-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.170.12.1069
更新日期:2005-12-01 00:00:00
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journal_title:Military medicine
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doi:
更新日期:1993-10-01 00:00:00
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journal_title:Military medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:2001-11-01 00:00:00
abstract::Isotonic, isosmotic lavage is a safe and effective means of mechanical preparation of the large bowel for left colon surgery. In this prospective, randomized trial comparing lavage with a more traditional three-day bowel preparation, the lavage was well tolerated, led to decreased preoperative hospital days, and produ...
journal_title:Military medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1989-04-01 00:00:00
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journal_title:Military medicine
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journal_title:Military medicine
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doi:10.7205/MILMED-D-12-00540
更新日期:2014-01-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1996-11-01 00:00:00
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journal_title:Military medicine
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doi:10.7205/MILMED-D-16-00256
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journal_title:Military medicine
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doi:
更新日期:1999-09-01 00:00:00
abstract::Adolescent pregnancy is a significant public health problem in the United States, but little is known about this condition in military-affiliated populations. This article reviews what is known about adolescent pregnancy among (1) dependent children of active duty and retired personnel and (2) active duty military per...
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journal_title:Military medicine
pub_type:
doi:
更新日期:2001-12-01 00:00:00
abstract::Acutely sprained ankles represent a frequent and common injury among active duty troops in training, and are a significant source of morbidity with respect to days lost to training. Swelling in the form of periarticular edema limits motion, causes pain, prevents wearing of normal foot gear, and slows the healing proce...
journal_title:Military medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1993-02-01 00:00:00
abstract::One hundred six astronaut applicants who had passed initial screening were evaluated for Axis I and Axis II DSM-III-R diagnoses using a structured psychiatric interview. Nine of 106 candidates (8.5%) met diagnostic criteria for six Axis I (including V-code), or Axis II disorders. The use of the NASA structured intervi...
journal_title:Military medicine
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doi:
更新日期:1993-01-01 00:00:00
abstract:INTRODUCTION:The purpose of this evaluation was to determine the effectiveness of the clinical nurse transition program (CNTP) for newly commissioned Army nurses. This is one of the first evaluations conducted to document the outcomes of the Army Nurse Corps (ANC) transition-to practice residency program. MATERIALS AN...
journal_title:Military medicine
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更新日期:2019-12-01 00:00:00
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更新日期:2013-04-01 00:00:00
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更新日期:2020-10-02 00:00:00
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更新日期:2012-06-01 00:00:00