论文标题
急诊室治疗时间的平均响应曲线
Average Response Curves for Treatment Time in the Emergency Department
论文作者
论文摘要
我们估计急诊科（ED）治疗时间的平均响应曲线。延长治疗时间被认为是改善入学决策的有前途解决方案。但是，为该解决方案提供经验支持是困难的，因为这种干预（治疗）是持续的事件。受患者健康需求不受约计的影响，并由入院决定（录取与出院）共同确定；并且可能只能修改，直到实现的时间转变。我们将录取过程正式为定向的无环图，并表明由于患者健康需求的混杂而无法确定，因此无法识别出治疗时间的平均反应曲线。因此，我们使用一个参数模型，该模型包括用于健康需求的潜在变量和入学过程的阈值回归模型。我们将该模型适合于大型三级教学医院的腹痛患者的观察数据（n = 28,862）。我们估计将ED治疗时间固定为2小时而不是1小时，从41.6％（95％CI：[40.6，42.7]）降低到32.7％（95％CI：[32.2，33.2]），而将实现的治疗时间降低了30分钟可以将入院时间降低为1.1％（95％CI：95％CI：[-1-1-1-1-1-1-1-1-2），[2]，3。2），3.2，[2]，3.2，[-1.1，3.2]，3.2，30分钟。再入院率。
We estimate average responses curves for treatment time in the Emergency Department (ED). Extending treatment time is considered a promising solution for improving admission decisions. Providing empirical support for this solution, however, is difficult because this intervention (treatment) is a continuous time-to-event; is strongly influenced by unmeasured patient health needs and is jointly determined with the admission decision (admit vs. discharge); and may be only modifiable up to a shift in the realized time. We formalize the admission process as a directed acyclic graph and show that average responses curves for treatment time cannot be identified nonparametrically due to unmeasured confounding from patient health needs. We thus use a parametric model that includes a latent variable for health needs and a threshold regression model for the admission process. We fit this model to observational data (n = 28,862) from abdominal pain patients at a large tertiary teaching hospital. We estimate that fixing ED treatment time to 2 hours rather than 1 hour decreases admission rates from 41.6% (95% CI: [40.6, 42.7]) to 32.7% (95% CI: [32.2, 33.2]) and that increasing the realized treatment time by 30 minutes can reduce admission rates by 1.1% (95% CI: [-1.1, 3.2]), with little change to 30-day revisit and readmission rates.
