慢性肺疾患のために必要な入院期間
A I Mushlin1, E R Black, C A Connolly
1Department of Medicine, University of Rochester School of Medicine, NY.
JAMA
|July 3, 1991
まとめ
慢性肺疾患の悪化のために医学的必要性のある入院期間は,診断関連グループ (DRG) の割り当てとは異なり,平均6~7日です. 臨床的要因は,COPD患者の長期滞在を予測することができます.
科学分野:
- 肺内医学は肺内医学である.
- 医療サービス 研究 医療サービス
- クリニカルアウトカム
背景:
- 慢性肺疾患 (COPD) の悪化による入院は,医療上の大きな負担を伴う.
- 必要な滞在期間 (LOS) の正確な予測は,リソースの配分と患者の管理に不可欠です.
- 診断関連グループ (DRG) システムは,払い戻しのために広く使用されていますが,常に臨床的ニーズを反映しているわけではありません.
研究 の 目的:
- COPDの悪化で入院した患者の臨床的に必要な滞在期間を決定する.
- 医学的に決定された LOS と DRG システムによって割り当てられた LOS を比較する.
- この患者集団において,より長い入院期間を予測する臨床的要因を特定する.
主な方法:
- 2つの急性ケア病院でCOPDの悪化のために入院した45歳以上の83人の患者を対象とした前向きなコホート研究.
- 合併症,重大な事故のモニタリング,および医学的に必要な LOS を確立するためにモニタリングの必要性.
- 医学的に派生したLOSとDRGが割り当てたLOSの統計的比較.
- LOSを予測するために入院時の臨床変数の分析.
主要な成果:
- 90%の患者は6日後に合併症やモニタリングを必要としなかった.
- 医学的に必要な平均LOSは6.9日,実際の平均LOSは8.7日でした.
- 医学的に必要なLOSとDRGによって割り当てられたLOSの相関は低く,統計的に有意ではありませんでした.
- 高PCO2,症状>1日,および抗生物質治療は,より長い入院を予測しました.
結論:
- 臨床的に示されたCOPD悪化のLOSは,患者の臨床イベントに基づいて約6〜7日です.
- DRGシステム LOSの計算は,COPD患者の実際の臨床要件と一致しない可能性があります.
- 入院時に特定の臨床的要因を特定することは,どのCOPD患者が長期滞在を必要とするかを予測するのに役立ちます.
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