Meiland F J M, Danse J A C, Wendte J F, Gunning-Schepers L J, Klazinga N S
Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
Health Policy. 2002 May;60(2):171-84. doi: 10.1016/s0168-8510(01)00209-3.
Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article focuses on the process and outcome of an urgency coding system in a fair selection of patients. It discusses the use of urgency codes in the daily practice of waiting list management and the related waiting times. Patients and their informal caregivers were followed from entry on the waiting list to admission to a nursing home. Caregivers were interviewed during the waiting period and after their relative's admission to a nursing home, and the formal urgency codes on the waiting list were monitored. Seventy-eight of the initial 93 patients were admitted to a nursing home. High urgency codes were commonly assigned and the waiting times were shorter for patients with higher urgency codes. Negative consequences of an urgency coding system, e.g. patients with less urgency not being admitted at all and patients not being admitted to the nursing home of their choice, could not be demonstrated. Patients without higher urgency codes were admitted after a mean waiting time of 28 weeks. It may be questioned whether this long waiting time is problematic, because satisfaction of the caregivers with regard to waiting times was not influenced by the actual waiting times. An urgency coding system enables health care professionals to react to changes in the situation of both patients and caregivers by adjusting urgency codes to influence the length of time until nursing home admission.
标准用于对医疗保健服务等候名单上的患者进行优先级排序。老年精神科护理院入院等候名单也是如此。患者在这些等候名单上的位置由紧迫性（变化）和等候时间决定。本文重点关注在公平挑选患者过程中紧迫性编码系统的流程和结果。它讨论了紧迫性编码在等候名单管理日常实践中的使用以及相关的等候时间。从患者进入等候名单到入住护理院，对患者及其非正式照料者进行跟踪。在等候期间以及他们的亲属入住护理院之后，对照料者进行访谈，并监测等候名单上的正式紧迫性编码。最初的93名患者中有78人入住了护理院。高紧迫性编码被普遍分配，紧迫性编码较高的患者等候时间较短。紧迫性编码系统的负面后果，例如紧迫性较低的患者根本未被收治以及患者未被收治到他们选择的护理院，并未得到证实。紧迫性编码不高的患者平均等候28周后入院。这么长的等候时间是否存在问题可能值得质疑，因为照料者对等候时间的满意度并未受到实际等候时间的影响。紧迫性编码系统使医疗保健专业人员能够通过调整紧迫性编码来应对患者和照料者情况的变化，从而影响直到入住护理院的时间长度。
