Characteristics and Operational Performance of Hospital-affiliated Freestanding Emergency Departments
| Autor: | Caroline Ledbetter, Kelly Bookman, Yang Wang, Avi Baehr, Adit A. Ginde, Jennifer L. Wiler |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Research design medicine.medical_specialty Operational performance Population Ambulatory Care Facilities American Community Survey 03 medical and health sciences 0302 clinical medicine Catchment Area Health Acute care Humans Medicine 030212 general & internal medicine education Aged Retrospective Studies education.field_of_study Insurance Health business.industry 030503 health policy & services Public Health Environmental and Occupational Health Retrospective cohort study Length of Stay Middle Aged Patient Acceptance of Health Care Hospitals Patient Discharge Health Care Surveys Insurance status Emergency medicine Female Catchment area Emergency Service Hospital 0305 other medical science business |
| Zdroj: | Medical Care. 58:234-240 |
| ISSN: | 0025-7079 |
| DOI: | 10.1097/mlr.0000000000001266 |
| Popis: | Background As there has been increasing pressure on acute care services to redefine how their care is delivered, hospital-affiliated freestanding emergency departments (FREDs) have rapidly expanded in some markets. Little is known about the populations served or the quality of care provided by these facilities. Objective The objective of this study was to compare patient visit characteristics, geographic catchment areas, and operational performance between hospital-affiliated FREDs and hospital-based emergency departments (HEDs). Research design This was a population-based retrospective observational analysis of 19 FREDs and 5 HEDs in a single health system over a 1-year period. We abstracted patient visit data from the electronic health record and supplemented catchment area data with the 2016 American Community Survey. We analyzed lengths of stay using generalized linear models adjusted for age, severity, and insurance status. Results FREDs had lower proportions of visits from nonwhite patients and more visits from privately insured patients than HEDs, with similar proportions of uninsured patient visits. These trends were mirrored in catchment area analyses. FRED visits were lower acuity, with fewer imaging and laboratory tests performed. The adjusted mean length of stay for discharged patients was 109 minutes for FREDs compared with 169 minutes for HEDs. For admitted or transferred patients, adjusted lengths of stay were 213 minutes at FREDs and 287 minutes at HEDs. Conclusions Hospital-affiliated FREDs serve more affluent and less diverse patient populations and geographic communities. Relative to HEDs, they have lower acuity patient visits with fewer tests, and they have shorter lengths of stay, even after adjustment for patient visit characteristics. |
| Databáze: | OpenAIRE |
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