在医院出院记录中衡量低价值护理:来自中国的证据
Tianjiao Lan1,2, Lingwei Chen3, Yifan Hu1
1HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
The Lancet regional health. Western Pacific
|October 4, 2023
概括
低价值外科手术的措施是在中国开发的,显示了整体适度,但在某些专业有显著的增长. 有针对性的干预措施至关重要,以减少这些昂贵和不必要的做法.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善外科手术的质量
- 卫生经济学 卫生经济学
背景情况:
- 低价值医疗,定义为医疗预计不会对患者有好处,在中国缺乏成熟的测量工具.
- 制定这些措施对于识别和减少非最佳外科手术实践至关重要.
研究的目的:
- 为中国的低价值手术程序开发和验证基于医院出院记录的措施.
- 评估这些程序的利用,支出和时间趋势.
- 分析医院内部不同低价值手术的实践模式和相关性.
主要方法:
- 通过使用基于证据的清单,创建了11个低价值外科手术的指标.
- 分析了来自四川省 (2016-2022) 的医院出院记录,以计算病例数,支出和保险支付.
- 使用关节点回归和多层模型来评估时间趋势和相关性.
主要成果:
- 低价值事件占程序的3.25%-71.66%和支出的5.90%-84.63%,具体取决于措施的具体性.
- 在2016-2022年期间,五种手术的发病率显著增加,其中四种手术的发病率每年增加超过20%.
- 在医院内不同低价值手术的比率之间没有发现显著的相关性.
结论:
- 虽然整体的低价值外科护理率很低,但特定的专业患病率很高,经济负担很大.
- 由于低价值实践的趋势越来越大,需要紧急的,具体的程序干预措施.
- 缺乏共同的驱动因素表明,为了减少中国的低价值护理,需要量身定制的方法.
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