Changes in the source of unscheduled hospitalizations in the United States.

摘要: BACKGROUND Hospitalizations represent a significant portion of the annual expenditures for US health care system. Understanding recent changes in sources unscheduled admissions may provide opportunities to improve quality and cost inpatient care. OBJECTIVES To examine hospitalization over 10-year period implications mortality length stay (LOS). RESEARCH DESIGN Observational study using 2000-2009 Nationwide Inpatient Sample. SUBJECTS We categorized hospitalizations as those related transfers, direct from outpatient providers, emergency department (ED). MEASURES Hospitalization rates by source clinical condition with multivariable regression analyses adjusted patient demographics, comorbid conditions, hospital factors evaluate associated LOS outcomes. RESULTS Unscheduled arising ED changed substantially while due transfers remained relatively stable. The admitted 64.9% [95% confidence interval (CI), 62.8%-66.9%] 2000, rising 81.8% (95% CI, 80.5%-83.1%) 2009, whereas providers correspondingly declined. In despite higher illness severity chronic disease burden, through compared was an overall lower odds ratio 0.85 0.77-0.93) shorter -0.84 -0.99 -0.70) days. CONCLUSIONS Sources United States have evolved, mostly resulting variety conditions now originating ED. This trend does not seem be harming patients or worsening LOS.