在NICU利用的变化:一个叙事审查和前进的路径
David A Paul1, Stephen A Pearlman2,3
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. neodp24@gmail.com.
概括
新生儿重症监护室 (NICU) 的使用差异很大,与患者的需要无关. 减少对晚期早产,早产和早产婴儿的不必要入院,可以降低成本并改善家庭体验.
科学领域:
- 新生儿医学 新生儿医学
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 新生儿重症监护室 (NICU) 的利用率在美国显示出显著的区域差异.
- 新生急症监护室的增长与患者需求或疾病严重程度的变化无关.
- 不必要的NICU入院造成大量成本,造成家庭压力,并可能增加医院获得的疾病.
研究的目的:
- 分析美国新生儿重症监护室 (NICU) 使用率的巨大差异.
- 确定导致不必要的婴儿重症监护室入院的因素,特别是晚期早产,早产和早产的婴儿.
- 提出减少不必要的NICU入院和相关负面后果的战略.
主要方法:
- 对NICU病床增长和利用率的国家趋势的分析.
- 检查影响脆弱婴儿群体NICU入院决定的因素.
- 对医院一级特征和可能推动利用的财务激励措施的审查.
主要成果:
- 新生病重症监护室的增长超过了需求,区域差异很大.
- 大多数NICU利用率的变化源于对晚期早产,早产和终产婴儿的照顾.
- 医院层面的因素,包括财务激励,似乎推动了不必要的NICU入院.
结论:
- 减少不必要的NICU入院对于优化资源配置和改善患者结果至关重要.
- 诸如护理区域化和修订出院流程等策略可以减轻差异.
- 应探索新生儿阿片类药物戒断综合征或新生儿重症监护室以外的败血症风险因素等疾病的替代护理模式.
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