Silber J H, Rosenbaum P R, Koziol L F, Sutaria N, Marsh R R, Even-Shoshan O
Center for Outcomes Research, Children's Hospital of Philadelphia, PA 19104-4318, USA.
Health Serv Res. 1999 Apr;34(1 Pt 2):349-63.
To develop and test a new outcome measure, Conditional Length of Stay (CLOS), to assess hospital performance when deaths are rare and complication data are not available.
The 1991 and 1992 MedisGroups National Comparative Data Base.
We use engineering reliability theory traditionally applied to estimate mechanical failure rates to construct a CLOS measure. Specifically, we use the Hollander-Proschan statistic to test if LOS distributions display an "extended" pattern of decreasing hazards after a transition point, suggesting that "the longer a patient has stayed in the hospital, the longer a patient will likely stay in the hospital" versus an alternative possibility that "the longer a patient has stayed in the hospital, the faster a patient will likely be discharged from the hospital."
DATA COLLECTION/EXTRACTION METHODS: Abstracted records from 7,777 pediatric pneumonia cases and 3,413 pediatric appendectomy cases were available for analysis.
For both conditions, the Hollander-Proschan statistic strongly displays an "extended" pattern of LOS by day 3 (p<.0001) associated with declining rates of discharge. This extended pattern coincides with increasing patient complication rates. Worse admission severity and chronic disease contribute to lower rates of discharge after day 3.
Patient stays tend to become prolonged after complications. By studying CLOS, one can determine when the rate of hospital discharge begins to diminish--without the need to directly observe complications. Policymakers looking for an objective outcome measure may find that CLOS aids in the analysis of a hospital's management of complicated patients without requiring complication data, thereby facilitating analyses concerning the management of patients whose care has become complicated.
开发并测试一种新的结局指标——条件住院时长（CLOS），用于在死亡罕见且无并发症数据时评估医院绩效。
1991年和1992年的MedisGroups国家比较数据库。
我们运用传统上用于估计机械故障率的工程可靠性理论来构建CLOS指标。具体而言，我们使用霍兰德 - 普罗尚统计量来检验住院时长（LOS）分布在一个转变点之后是否呈现出危险率下降的“延长”模式，这表明“患者在医院停留的时间越长，其可能停留的时间就越长”，而非另一种可能性，即“患者在医院停留的时间越长，其出院的速度可能越快”。
数据收集/提取方法：可获取7777例小儿肺炎病例和3413例小儿阑尾切除术病例的摘要记录用于分析。
对于这两种疾病，霍兰德 - 普罗尚统计量在第3天时强烈显示出住院时长的“延长”模式（p<0.0001），且与出院率下降相关。这种延长模式与患者并发症发生率的增加相吻合。入院病情较重和患有慢性病会导致第3天后出院率降低。
并发症发生后患者住院时间往往会延长。通过研究CLOS，可以确定医院出院率何时开始下降——而无需直接观察并发症情况。寻求客观结局指标的政策制定者可能会发现，CLOS有助于在无需并发症数据的情况下分析医院对复杂患者的管理，从而便于对护理已变得复杂的患者的管理进行分析。
