Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Yudai Honda, Jung-Ho Shin, Susumu Kunisawa, Kiyohide Fushimi, Yuichi Imanaka
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Abstract

Background: Early mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this fee is unknown.

Objective: To measure the proportion of ICU patients who received early rehabilitation and the impact on length of ICU stay, the length of hospital stay and discharged to home after the introduction of the financial incentive (additional fee for early mobilisation and/or rehabilitation).

Design/methods: We included patients who were admitted to ICU within 2 days of hospitalisation between April 2016 and January 2020. We conducted interrupted time series analyses to assess the effects of the introduction of the financial incentive.

Results: The proportion of patients who received early rehabilitation immediately increased after the introduction of the financial incentive (rate ratio (RR) 1.293, 95% CI 1.240 to 1.349). The RR for proportion of patients received early rehabilitation was 1.008 (95% CI 1.005 to 1.011) in the period after the introduction of the financial incentive compared with period before its introduction. There was no statistically significant change in the mean length of ICU stay, the mean length of hospital stay and the proportion of patients who were discharged to home.

Conclusion: After the introduction of the financial incentive, the proportion of ICU patients who received early rehabilitation increased. However, the effects of the financial incentive on the length of ICU stay, the length of hospital stay and the proportion of patients who were discharged to home were limited.

经济激励对重症监护病房患者早期康复和疗效的影响:日本的一项回顾性数据库研究。
背景:重症监护病房(ICU)患者的早期康复是临床实践指南中的一项建议。因此,日本的全民健康保险制度引入了早期活动和/或康复的额外费用,医院可在重症监护病房患者入院后 48 小时内开始康复治疗时收取该费用。然而,该费用的效果尚不清楚:目的:测量在引入经济激励措施(早期活动和/或康复的额外费用)后,接受早期康复治疗的 ICU 患者的比例,以及对 ICU 住院时间、住院时间和出院回家时间的影响:我们纳入了 2016 年 4 月至 2020 年 1 月期间住院 2 天内入住 ICU 的患者。我们进行了间断时间序列分析,以评估引入经济激励措施的效果:引入经济激励措施后,接受早期康复治疗的患者比例立即增加(比率比(RR)为 1.293,95% CI 为 1.240 至 1.349)。与激励措施实施前相比,激励措施实施后接受早期康复治疗的患者比例的比率为 1.008(95% CI 1.005 至 1.011)。重症监护室的平均住院时间、平均住院时间和出院回家的患者比例在统计学上没有明显变化:结论:引入经济激励机制后,接受早期康复治疗的重症监护室患者比例有所增加。然而,经济激励措施对重症监护室住院时间、住院时间和出院回家比例的影响有限。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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