2011年至2017年,退伍军人事务医院的急性住院和结果
Jean Yoon1,2,3, Ciaran S Phibbs1,2,4, Michael K Ong5,6,7
1Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA.
Medicine
|July 26, 2024
概括
退伍军人事务 (VA) 医院看到更多的观察护理,导致30天死亡率下降,但再入院没有变化. 这一转变影响了VA医院的绩效指标.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善医疗保健质量 改善医疗保健质量
- 卫生经济学 卫生经济学
背景情况:
- 退伍军人事务 (VA) 医疗保健系统内的医院越来越多地使用观察护理.
- 目前,观察护理并未包括在标准的急性住院患者绩效指标中.
- 这一转变对VA医院绩效的影响尚不清楚.
研究的目的:
- 为了检查VA住院结果的变化.
- 为了确定急性住院护理转移到观察护理是否影响了这些结果.
主要方法:
- 从2011年到2017年,对11个州的986355例住院和观察期间进行了纵向分析.
- 估计30天死亡率,30天再入院,成本和停留时间 (LOS) 的时间变化.
- 死亡率和再接收变化的比较,包括观察护理数据和不包括观察护理数据.
主要成果:
- 急性住院病例减少了9%,而在2011年至2017年期间,观察期间的住院病例增加了157%.
- 包括观察停留时间在内,显示30天死亡率下降 (P < .05),但30天再接收并没有显著变化.
- 平均医疗保健费用略有增加,平均LOS保持不变. 在不同的医疗状况中观察到显著的差异.
结论:
- 越来越多地在VA医院使用观察护理与30天死亡率的降低有关.
- 尽管死亡率发生了变化,但转向观察护理并没有改善VA系统内的30天再入院率.
- 医疗保健系统的绩效指标需要考虑观察护理,以准确反映患者的结果.
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