两张病床之间:医院不适当地延迟出院。

Tor Helge Holmås, Mohammad Kamrul Islam, Egil Kjerstad
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引用次数: 25

摘要

承认医院和社会护理服务部门在治疗和护理慢性病和复杂疾病患者方面分工的必要性,就是承认保健提供者之间存在潜在的利益冲突。一个潜在的重要冲突是,在其他条件相同的情况下,医院倾向于相对较短的住院时间(LOS),而社会护理服务则倾向于较长的住院时间。此外,不适当地延迟出院,即床位阻塞,对社会来说代价高昂。我们的目的是讨论哪些因素可能影响床位阻塞,并使用挪威患者个人数据,与社会护理和医院数据合并,量化床位阻塞成本。这些数据使我们能够将医院的住院时间划分为适当住院时间(LAS)和延迟时间(LOD),即床位阻塞时间。我们发现分配给社会护理服务的额外资源有助于缩短LOD,这表明社会护理服务可能会利用医院资源作为能力不足的缓冲。LAS随着医疗复杂性的增加而增加,这表明医院减少LOS的动机因考虑到患者的医疗需求而减弱。床位阻塞费用在住院护理总费用中占比较大的份额。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Between two beds: inappropriately delayed discharges from hospitals.

Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.

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