一家公共医院关闭. 对患者获得护理和健康状况的影响
A B Bindman1, D Keane, N Lurie
1Department of Medicine, San Francisco General Hospital, CA 94110.
JAMA
|December 12, 1990
概括
关闭一家公立医院显著减少了患者获得医疗保健的机会,并对健康状况产生了负面影响. 患者在获得护理方面遇到更大的困难,整体幸福感下降.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 患者的治疗结果.
背景情况:
- 公共医院在确保社区获得医疗保健方面发挥着至关重要的作用.
- 医院关闭可能会对弱势群体产生不成比例的影响,并加剧健康差距.
- 了解公共医院关闭的后果对于为卫生政策提供信息至关重要.
研究的目的:
- 评估公立医院关闭对患者获得医疗保健服务的影响.
- 评估医院关闭后患者健康状况的后续变化.
- 为了比较一个医院关闭的县和一个没有关闭的对照县的结果.
主要方法:
- 采用了比较性研究设计,调查了沙斯塔县 (医院关闭) 和圣路易斯奥比斯波县 (医院保持开放) 的住院患者.
- 在关闭前和1年后进行了调查,评估定期提供者访问,拒绝护理和健康状况,使用医学结果研究简单表格.
- 纵向数据分析比较了两个县之间的访问和健康结果的变化.
主要成果:
- 沙斯塔县的患者报告没有定期提供者 (14.0%至27.7%) 和被拒绝照顾 (10.8%至16.9%) 的患者显著增加.
- 相比之下,圣路易斯奥比斯波县的患者报告说,他们可以更好地接触常规医疗服务提供者,而拒绝医疗的水平没有改变.
- 与圣路易斯奥比斯波县患者相比,沙斯塔县患者的感知健康,社会/角色功能显著下降,并报告疼痛增加.
结论:
- 沙斯塔总医院的关闭对患者获得医疗保健服务产生了不利影响.
- 在受公共医院关闭影响的县患者中观察到健康状况的显著下降.
- 公共医院的关闭可能会导致不良健康结果和减少医疗保健的可获得性,强调需要仔细考虑政策.
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