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远程分诊、医疗替代与健康:来自准随机分配护士的证据

Tele-triage, care substitution, and health: Evidence from quasi-randomly assigned nurses
Journal of Health Economics · 2026 · Liam Rose、K Suzuki、Linda Diem Tran、Anita A. Vashi

中文摘要

出现急性健康症状的患者常常面临如何就医、去哪里就医的不确定性。我们研究致电护士咨询热线的患者,他们获得四种建议之一:急诊科(ED)、紧急护理(UC)、初级保健(PC)或自我照护(居家)。利用"审查者设计"(examiner designs)的一个扩展来恢复每对相邻建议(ED–UC、UC–PC、PC–Home)的边际特定效应,我们估计了护士建议对患者决策及其后续健康结果的影响。我们发现,建议在每个边际上都对患者决策有很大影响。我们进一步表明,与急诊科建议相比,紧急护理建议使28天医疗费用降低404美元;与初级保健建议相比降低247美元,这表明通过改进分诊实现成本节约的潜力巨大。

Abstract

Patients experiencing acute health symptoms often face uncertainty about how and where to receive care. We study patients who call a nurse advice line and receive one of four recommendations: emergency department (ED), urgent care (UC), primary care (PC), or self-care (Home). Leveraging an extension of examiner designs that recovers margin-specific effects for each pair of adjacent recommendations (ED-UC, UC-PC, PC-Home), we estimate the impact of nurse recommendations on both patient decisions and their subsequent health outcomes. We find that recommendations have large impacts on patient decisions at each margin. We then show that UC recommendations reduce 28-day healthcare costs by $404 relative to ED recommendations and by $247 relative to PC recommendations, suggesting substantial potential for cost savings through improved triage.
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