Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Comparing least-squares and quantile regression approaches to analyzing median hospital charges.
Emergency department (ED) and hospital charges obtained from administrative data sets are useful descriptors of injury severity and the burden to EDs and the health care system. However, charges are typically positively skewed due to costly procedures, long hospital stays, and complicated or prolonged treatment for few patients. The median is not affected by extreme observations and is useful in describing and comparing distributions of hospital charges. A least-squares analysis employing a log transformation is one approach for estimating median hospital charges, corresponding confidence intervals (CIs), and differences between groups; however, this method requires certain distributional properties. An alternate method is quantile regression, which allows estimation and inference related to the median without making distributional assumptions. ⋯ Quantile regression analyses of hospital charges provide unbiased estimates even when lognormal and equal variance assumptions are violated. These methods may be particularly useful in describing and analyzing hospital charges from administrative data sets.
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The objective was to determine whether insurance status is associated with the care of patients presenting to the emergency department (ED). ⋯ Nonprivate insurance status is associated with different care patterns in adults aged 19 to 64 years visiting the ED. Further studies are needed to evaluate how these disparate care patterns affect health outcomes.
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The objective was to identify the correlates of willingness to pay for ambulance transports from a rural city to a regional hospital in Guatemala. ⋯ The primary correlates of willingness to pay for ambulance transport in Santiago Atitlán, Guatemala, are household income, location of residence (rural district vs. urban district), and respondents' education levels. Furthermore, severity of emergency significantly appears to influence how much individuals are willing to pay for ambulance transport. Willingness-to-pay information may help public health planners in resource-poor settings develop price scales for health services and achieve economically efficient allocations of subsidies for referral ambulance transport.
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Ultrasound (US) has well-documented utility in critical procedures performed in the emergency department. It has been described as a "skill integral to the practice of emergency medicine" in the 2007 Model of Clinical Practice of Emergency Medicine. One of the ideal uses for US in critical care may be in the performance of emergent cricothyroidotomy. To the best of our knowledge there is currently no description of how to perform an US-guided open cricothyroidotomy in the literature. ⋯ Ultrasound-guided bougie-assisted cricothyroidotomy is a novel technique that may be beneficial in emergent open cricothyroidotomy. The data suggest that this technique is rapid, with a median time to completion of 26.2 seconds. The data also suggest that the procedure may have a low failure rate, with 20 of 21 cadavers undergoing successful cricothyroidotomy.
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The Institute of Medicine has stated that analyzing data according to sex and gender may change practices used by clinicians and taught in medical education. Gender-specific medicine embraces the concept that differences between men and women encompass the entire organism, not just their reproductive biology, and that recognizing these differences will improve the precision and quality of health care for both men and women. Research conducted to date has deepened our scientific understanding of sex and gender differences in the etiology, diagnosis, progression, outcomes, treatment, and prevention of many conditions that affect both women and men. ⋯ Collaborations between women's health researchers across fields of medicine will be essential, given the large knowledge deficits to be addressed and the gender-based issues that span all specialties. We provide one model for a multifaceted initiative targeting improvements in gender medicine for the specialty of EM. If emergency health services are to meet the needs of both women and men at modern-day standards, then they must acknowledge the emerging science demonstrating that sex and gender differences influence the delivery of high-quality clinical care.