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Performance, Training, QualityAssurance, and Reimbursement ofEmergency Physician–PerformedUltrasonography at Academic MedicalCenters
Moore CL, Gregg S, Lambert M(Yale University, New Haven, CT; Resurrection Medical CenterEmergency Medicine Residency, Chicago, IL)J Ultrasound Med. 2004;23:459-466
Background: Ultrasonography has become a widely used
diagnostic tool inmanyspecialties. However, the amount and
character of the training required to attain competence in
performing and interpreting ultrasonography remain a con-
troversial issue. In recent years, hospital privileging and
credentialing issues have gained prominence. Emergency
physician–performed ultrasonography is increasingly being
incorporated into the curriculum of emergency medicine
residency programs in the United States. Bedside emer-
gency physician–performed ultrasonography has been
shown to be helpful in diagnosing and excluding a variety of
emergent conditions. The purpose of this study is to assess
the current state of bedside emergency physician–per-
formed ultrasonography in terms of prevalence, training,
quality assurance, and reimbursement at emergency medi-
cine residency programs.
Methods: A 10-questionWeb-based surveywas e-mailed to
ultrasonography/residency directors at 122 emergency
medicine programs in the United States.
Results: The response rate was 84%. Of the programs
responding, 92% of programs reported that 24-hour emer-
gency physician–performed ultrasonography was available.
A slight majority of programs (51%) reported that a creden-
tialing/privileging planwas in place at their hospital, and 71%
of programs had a quality assurance/image review pro-
cedure in place. Guidelines specific to emergency medicine
for 150 ultrasonographic examinations and 40 hours of
instruction were met by 39% and 22% of residencies,
respectively, although only 13.7% of programs were com-
ABSTRACTS
Characteristics of Occasional andFrequent Emergency Department Users:Do Insurance Coverage and Access toCare Matter?
Zuckerman S, Shen Y-C(Urban Institute, Washington, DC)Med Care. 2004;42:176-182
Background: Between 1992 and 2001, emergency depart-
ment (ED) visits increased by 20% in the United States.
However, in any given year, most people do not use an ED.
Research has shown that, in 1999, about 1 in 5 adults sought
care at an ED, with approximately 7% seeking ED care 2 or
more times during the 12-month study period. The current
study investigated how insurance coverage, access to care,
and other individual characteristics are related to differ-
ences in ED use among the general population.
Methods: Data were obtained from the 1997 and 1999
National Survey of America’s Families, a nationally repre-
sentative sample. Based on number of ED visits during the 12
months preceding the survey, people were classified into 3
groups: non-ED users (with no visits), occasional ED users
(with 1 or 2 visits), and frequent ED users (with �3 visits). A
multinomial logit model was used to estimate the effect of
insurance status and other factors on ED use levels.
Findings: Persons with fair or poor health were 3.64 times
more likely than others to be frequent users compared with
nonusers. Uninsured and privately insured adults had the
same risk of being frequent users. However, publicly insured
adults were 2.08 times more likely to be frequent users.
Adults making 3 or more visits to physicians during the 12-
month period were 5.29 times more likely to be frequent ED
users than those making no visits to physicians.
Conclusion: Contrary to popular belief, the uninsured do not
appear to use ED care more than insured populations. In
addition, frequent ED users do not appear to use ED visits as
a substitute for primary care visits. Rather, they are a less
healthy population who need and use more care overall.
Comment: This nicely done study emphasizes a couple of
important points: (1) frequent users of the ED are sicker and
probably more chronically ill than non-ED users or occa-
sional ED users; (2) adhering to the simplistic idea that
decreasing ED visits for nonurgent problems will fix ED
crowding ignores the real issue: our health care system is
5 5 4
broken; and (3) ED crowding needs to be addressed on
multiple fronts.
Rita K. Cydulka, MD, MS
doi:10.1016/j.annemergmed.2004.08.031
ANNALS OF EMERGENCY MEDIC INE 44 : 5 NOVEMBER 20 04