面对Covid-19的法国医院弹性：以往执业质量对癌症手术恢复影响的多层次分析

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-03-28 DOI:10.1016/j.healthpol.2025.105309

Noémie Malléjac , Zeynep Or

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引用次数: 0

摘要

2019冠状病毒病大流行扰乱了医院的常规服务，导致2020年大量手术积压。本研究调查了大流行期间恢复活动的医院复原力，重点关注大流行前消化道癌症手术中采用增强术后恢复方案（ERAS）的影响。ERAS涉及以患者为中心的护理方案，已被证明可以改善护理过程和结果，但尚未在医院系统地实施。我们将医院复原力定义为在大流行期间保持和恢复2020年下半年手术水平的能力。使用法国国家医院的消化癌手术数据，我们根据大流行前的ERAS体积强度对医院进行了分类，并估计了一个多层模型，允许控制医院特征和大流行情况。结果表明，在其他条件相同的情况下，在大流行之前实施ERAS的医院吸收了积压的手术，并更快地恢复了大流行前的活动水平。大型医院和专科癌症中心的手术恢复速度也比其他医院快。研究结果强调了各医院护理实践的差异，以及在健康危机期间加强医院复原力的质量协议的重要性。除了改善患者的治疗效果外，广泛采用此类方案还可以提高医疗保健资源的利用率，并有助于减轻更广泛的经济和环境压力。

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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Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption

The COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated.

Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures.

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.