减少内科不适当入院所带来的成本节约和健康损失。
Cost savings and health losses from reducing inappropriate admissions to a department of internal medicine.
作者信息
Eriksen B O, Førde O H, Kristiansen I S, Nord E, Pape J F, Almdahl S M, Hensrud A, Jaeger S, Mürer F A
机构信息
University Hospital of Tromsø.
出版信息
Int J Technol Assess Health Care. 2000 Autumn;16(4):1147-57. doi: 10.1017/s0266462300103186.
OBJECTIVES
Inappropriate hospital admissions are commonly believed to represent a potential for significant cost reductions. However, this presumes that these patients can be identified before the hospital stay. The present study aimed to investigate to what extent this is possible.
METHODS
Consecutive admissions to a department of internal medicine were assessed by two expert panels. One panel predicted the appropriateness of the stays from the information available at admission, while final judgments of appropriateness were made after discharge by the other.
RESULTS
The panels correctly classified 88% of the appropriate and 27% of the inappropriate admissions. If the elective admissions predicted to be inappropriate had been excluded, 9% of the costs would have been saved, and 5% of the gain in quality-adjusted life-years lost. The corresponding results for emergency admissions were 14% and 18%.
CONCLUSIONS
The savings obtained by excluding admissions predicted to be inappropriate were small relative to the health losses. Programs for reducing inappropriate health care should not be implemented without investigating their effects on both health outcomes and costs.
目的
人们普遍认为不适当的住院治疗存在大幅降低成本的潜力。然而，这是假定这些患者在住院前就能被识别出来。本研究旨在调查这种可能性有多大。
方法
由两个专家小组对内科某科室的连续入院病例进行评估。一个小组根据入院时可得的信息预测住院的适当性，而另一个小组在患者出院后做出关于适当性的最终判断。
结果
两个小组正确分类了88%的适当入院病例和27%的不适当入院病例。如果排除那些预计为不适当的择期入院病例，可节省9%的成本，同时减少5%的质量调整生命年损失。急诊入院病例的相应结果分别为14%和18%。
结论
相对于健康损失而言，通过排除预计为不适当的入院病例所节省的费用较少。在未调查其对健康结果和成本的影响之前，不应实施减少不适当医疗保健的项目。
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