巴西的长时间住院治疗:临床需要还是系统性失败?
1Universidade Federal de Ciências da Saúde de Porto Alegre, Medical School, Department of Internal Medicine and Rehabilitation Sciences - Porto Alegre (RS), Brazil.
Revista da Associacao Medica Brasileira (1992)
|October 31, 2025
概括
大多数住院日是不必要的,是由于系统性延迟而不是临床需求. 诊断和专家瓶显著延长了患者的住院时间,特别是在巴西的公共统一卫生系统 (SUS).
科学领域:
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
- 医院运营 医院运营
背景情况:
- 长时间住院带来不良事件和资源过度使用的风险.
- 巴西的双重公私医疗保健系统在了解住院时间 (LOS) 方面提出了独特的挑战.
- 将临床必要性与LOS系统性延迟区分开来,对于医疗保健的效率至关重要.
研究的目的:
- 量化导致医疗住院LOS的临床和非临床因素.
- 为了比较巴西公共 (统一卫生系统 (SUS)) 和私人保险患者之间的LOS模式.
主要方法:
- 在巴西三家医院 (2009-2022) 接受5423名成人内科患者的前性多中心队列研究.
- 每日医生评估住院的必要性与延迟 (诊断,专家,行政,社会).
- 多变量统计模型调整为并发症和脆弱性.
主要成果:
- 平均LOS为11.8天;只有38% (4.5天) 在临床上是合理的.
- 非临床延迟占LOS的大多数,主要来自诊断 (2.9天) 和专家输入 (1.9天).
- 统一卫生系统 (SUS) 患者的LOS比私人保险患者 (10.1天) 长 (13.2天),住院时间延长的几率更高,测试和专家评估的延迟更大,即使经过调整.
结论:
- 大多数住院日的原因不是临床必要性,而是系统性延迟.
- 诊断和专家延迟是长期LOS的主要原因,特别是在公共卫生保健系统内.
- 调查结果凸显了巴西的结构性低效率以及急需改革医疗保健系统的迫切需要.
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