Abstract:
STUDY OBJECTIVE:Patient-centered medical homes are primary care practices that focus on coordinating acute and preventive care. Such practices can obtain patient-centered medical home recognition from the National Committee for Quality Assurance. We compare growth rates for emergency department (ED) use and costs of ED visits and hospitalizations (all-cause and ambulatory-care-sensitive conditions) between patient-centered medical homes recognized in 2009 or 2010 and practices without recognition. METHODS:We studied a sample of US primary care practices and federally qualified health centers: 308 with and 1,906 without patient-centered medical home recognition, using fiscal year 2008 to 2010 Medicare fee-for-service data. We assessed average annual practice-level payments per beneficiary for ED visits and hospitalizations and rates of ED visits and hospitalizations (overall and ambulatory-care-sensitive condition) per 100 beneficiaries before and after patient-centered medical home recognition, using a difference-in-differences regression model comparing patient-centered medical homes and propensity-matched non-patient-centered medical homes. RESULTS:Comparing patient-centered medical home with non-patient-centered medical home practices, the rate of growth in ED payments per beneficiary was $54 less for 2009 patient-centered medical homes and $48 less for 2010 patient-centered medical homes relative to non-patient-centered medical home practices. The rate of growth in all-cause and ambulatory-care-sensitive condition ED visits per 100 beneficiaries was 13 and 8 visits fewer for 2009 patient-centered medical homes and 12 and 7 visits fewer for 2010 patient-centered medical homes, respectively. There was no hospitalization effect. CONCLUSION:From 2008 to 2010, outpatient ED visits increased more slowly for Medicare patients being treated by patient-centered medical home practices than comparison non-patient-centered medical homes. The reduction was in visits for both ambulatory-care-sensitive and non-ambulatory-care-sensitive conditions, suggesting that steps taken by practices to attain patient-centered medical home recognition such as improving care access may decrease some of the demand for outpatient ED care.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Pines JM,Keyes V,van Hasselt M,McCall Ndoi
10.1016/j.annemergmed.2015.01.002subject
Has Abstractpub_date
2015-06-01 00:00:00pages
652-60issue
6eissn
0196-0644issn
1097-6760pii
S0196-0644(15)00003-7journal_volume
65pub_type
杂志文章abstract:STUDY OBJECTIVE:The objectives of this systematic review and meta-analysis are to appraise the evidence in regard to the diagnostic accuracy of a low-risk History, ECG, Age, Risk Factors, and Troponin (HEART) score for prediction of major adverse cardiac events in emergency department (ED) patients. These included 4 su...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,meta分析
doi:10.1016/j.annemergmed.2018.12.010
更新日期:2019-08-01 00:00:00
abstract:STUDY OBJECTIVE:We describe current alcohol screening and brief intervention practices in emergency departments (EDs) at Level I and Level II trauma centers and characterize ED directors' attitudes and perceived barriers associated with these practices among injured patients in the ED. METHODS:ED directors at Level I ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
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更新日期:2010-06-01 00:00:00
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journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2006.01.008
更新日期:2006-09-01 00:00:00
abstract:STUDY OBJECTIVE:Advanced, out-of-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among noninjured patients. We evaluate the association between out-of-hospital, intravenous access and mortality among noninjured, ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2011.07.021
更新日期:2012-04-01 00:00:00
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journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.10.007
更新日期:2017-04-01 00:00:00
abstract::Our study was conducted to determine the appropriate dose of lidocaine using the larynx and to characterize the onset and duration of therapeutic serum levels. A mean dose of 5.67 +/- 1.2 mg/kg was topically administered to the subglottic region of seven comatose patients through a cricothyroid membrane puncture. Seri...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(82)80062-0
更新日期:1982-09-01 00:00:00
abstract:STUDY OBJECTIVES:To compare diagnostic strategies for the emergency assessment of patients with suspected acute thoracic aortic dissection and to measure the effect of delays related to the availability of these tests on the selection of the most appropriate one. METHODS:We carried out a decision analysis representing...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70026-4
更新日期:1996-09-01 00:00:00
abstract::A 36-year-old man developed extreme shortness of breath after injecting "freebase" cocaine intravenously. Clinical and radiographic evaluation confirmed acute pulmonary edema, and blood gas studies substantiated acute respiratory failure. Despite vigorous therapy, the patient died three hours after admission. When coc...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80314-9
更新日期:1981-08-01 00:00:00
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journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.05.022
更新日期:2020-10-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the clinical efficacy and safety of IV adenosine administration in the field for the treatment of paroxysmal supraventricular tachycardia (PSVT). DESIGN:Prospective, consecutive case series. SETTING:An urban emergency medical services system. PARTICIPANTS:Thirty-seven adult patients in w...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82650-2
更新日期:1992-04-01 00:00:00
abstract::Life-threatening hypothermia can be treated by active and passive rewarming techniques, the treatment of choice being partial cardiopulmonary bypass. The use of closed thoracic cavity lavage has been evaluated in animals, but no formal presentations in human beings have been reported. We report two cases in which rapi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81810-4
更新日期:1990-02-01 00:00:00
abstract:STUDY OBJECTIVES:To determine the incidence of needlestick injury among paramedics working in Florida during 1987, to describe the circumstances surrounding such injuries, and to assess the hepatitis B vaccination status of this group. DESIGN:Survey of a systematic random sample of paramedics using a self-administered...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81072-8
更新日期:1991-12-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluated the influence of home visiting on the risk for medically attended unintentional injury during home visiting (0 to 3 years) and subsequent to home visiting (3 to 5 years). METHODS:A retrospective, quasi-experimental study was conducted in a cohort of mother-child pairs in Hamilton County, O...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2017.01.029
更新日期:2017-09-01 00:00:00
abstract:STUDY OBJECTIVE:Urinary catheters are often placed in the emergency department (ED) and are associated with an increased safety risk for hospitalized patients. We evaluate the effect of an intervention to reduce unnecessary placement of urinary catheters in the ED. METHODS:Eighteen EDs from 1 health system underwent t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2014.02.013
更新日期:2014-06-01 00:00:00
abstract:STUDY OBJECTIVE:In 2001, less than 20% of emergency medicine residents had more than $150,000 of educational debt. Our emergency medicine residents anecdotally reported much larger debt loads. Surveys have reported that debt affects career and life choices. Qualitative approaches are well suited to explore how and why ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.04.013
更新日期:2016-10-01 00:00:00
abstract::Patients evaluated by paramedics but not transported to the hospital account for 50% to 90% of emergency medical services lawsuits. We reviewed 2,698 consecutive paramedic run reports to examine documentation in these cases. Documentation criteria for prehospital patient release were history, physical examination, vit...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82187-0
更新日期:1990-05-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department. METHODS:We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the In...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/s0196-0644(99)80051-1
更新日期:1999-10-01 00:00:00
abstract::A 19-year-old man who attempted suicide by ingesting approximately 600 mg fluoxetine (Prozac) and 140 mg loxapine (Loxitane) had two episodes of atrial flutter shortly thereafter. Admission serum fluoxetine, norfluoxetine, and loxapine levels were 1,053 ng/mL, 702 ng/mL, and 40 ng/mL, respectively. This case of atrial...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70083-4
更新日期:1994-03-01 00:00:00
abstract::Leeches have been used as a medicinal remedy for years untold. Recently, there appears to have been a resurgence in the use of the medicinal leech, Hirudo medicinalis. Presented is the case of a patient who called the emergency department for advice concerning the management of a bleeding leech bite. We discuss briefl...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80422-6
更新日期:1989-03-01 00:00:00
abstract:STUDY OBJECTIVE:We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures. METHODS:We conducted a prospective, randomized, double-blind, placebo-controlled, clinical trial in a tertiary pediatric ED bet...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2006.06.016
更新日期:2007-03-01 00:00:00
abstract::One hundred forty-one medical schools were surveyed to determine the emergency medicine core content topics and skills being taught in the curricula. Responses were obtained from 96 schools through two mailings and a telephone followup. Most topics surveyed were offered in the vast majority of medical schools (greater...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80478-4
更新日期:1986-01-01 00:00:00
abstract::A characteristic case of overwhelming postsplenectomy infection in a previously healthy, 25-year-old man is presented. The patient progressed from influenza-like symptoms to irreversible septic shock and death within 24 hours. His spleen had been removed nine years earlier because of abdominal trauma. Aggressive thera...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(88)80304-4
更新日期:1988-02-01 00:00:00
abstract:STUDY OBJECTIVE:We describe the recidivism characteristics of an adult emergency department (ED) observation unit population and determine whether rates differ according to demographic or clinical features. METHODS:This prospective observational cohort study of a protocol-driven ED observation unit reviewed all discha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.02.012
更新日期:2010-07-01 00:00:00
abstract::After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(03)00447-5
更新日期:2003-09-01 00:00:00
abstract::Gastrointestinal obstruction is a rare complication of multiple-dose administration of activated charcoal. Previous reports deal only with obstruction after ingestion of drugs that impair gastrointestinal motility. This patient developed a small-bowel obstruction associated with the administration of multiple doses of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70170-9
更新日期:1994-07-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the association between use of specific cephalosporins and macrolides and hospital length of stay in patients with sickle cell disease (SCD) who are admitted with acute chest syndrome, and determine treatment risk factors for acute chest syndrome-related 30-day readmission. METHODS:Patient...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.08.011
更新日期:2020-09-01 00:00:00
abstract::Although all emergency physicians are familiar with catastrophic causes of free intraperitoneal air, we describe the case of a healthy 26-year-old woman who presented to our emergency department (ED) with a nonsurgical and previously unreported cause of pneumoperitoneum. The patient presented to our ED with complaints...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2015.02.011
更新日期:2015-08-01 00:00:00
abstract:STUDY OBJECTIVE:Anecdotal concerns suggest that health management organization (HMO) membership instructions may deter members from calling 911 or going to an emergency department for a perceived emergency. This study examines such instructions, specifically in regard to their definition of an emergency condition and a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(99)70267-2
更新日期:1999-07-01 00:00:00
abstract:STUDY OBJECTIVE:The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death. METHODS:Fatalities that involved a ch...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.09.015
更新日期:2009-04-01 00:00:00
abstract:STUDY OBJECTIVE:We explore what emergency physicians with access to health information exchange have to say about it and strive to better understand the factors affecting their use of it. METHODS:A qualitative study using grounded theory principles was conducted in 4 urban emergency departments that had health informa...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2013.09.024
更新日期:2014-03-01 00:00:00