Jiménez Rosa E, Lam Rosa M, Marot Milagros, Delgado Ariel
Hermanos Ameijeiras General Hospital, Research and Projects Department, San Lázaro 701, Centro Habana 10300, Ciudad Habana, CUBA.
BMC Health Serv Res. 2004 Feb 17;4(1):4. doi: 10.1186/1472-6963-4-4.
Length of stay (LOS) is an important indicator of efficiency for inpatient care but it does not achieve an adequate performance if it is not adjusted for the case mix of the patients hospitalized during the period considered. After two similar studies for Internal Medicine and Surgery respectively, the aims of the present study were to search for Length of Stay (LOS) predictors in an acute psychiatric department and to assess the performance of the difference: observed-predicted length of stay, as an indicator of inpatient care inefficiencies.
Retrospective case-series of patients discharged during 1999 from the Psychiatric Department from General Hospital "Hermanos Ameijeiras" in Havana, Cuba. The 374 eligible medical records were randomly split into two groups of 187 each. We derived the function for estimating the predicted LOS within the first group. Possible predictors were: age; sex; place of residence; diagnosis, use of electroconvulsive therapy; co morbidities; symptoms at admission, medications, marital status, and response to treatment. LOS was the dependent variable. A thorough exam of the patients' records was the basis to assess the capacity of the function for detecting inefficiency problems, within the second group.
The function explained 37% of LOS variation. The strongest influence on LOS came from: age (p = 0.002), response to treatment (p < 0.0001), the dummy for personality disorders (p = 0.01), ECT therapy (p = 0.003), factor for sexual and/or eating symptoms (p = 0.003) and factor for psychotic symptoms (p = 0.025). Mean observed LOS is 2 days higher than predicted for the group of records with inefficient care, whereas for the group with acceptable efficiency, observed mean LOS was 4 days lower than predicted. The area under the ROC curve for detecting inefficiencies was 69%
This study demonstrates the importance of possible predictors of LOS, in an acute care Psychiatric department. The proposed indicator can be readily used to detect inefficiencies.
住院时间（LOS）是住院治疗效率的一项重要指标，但如果不对所考虑期间内住院患者的病例组合进行调整，它就无法充分体现其性能。在分别针对内科和外科进行了两项类似研究之后，本研究的目的是在急性精神科寻找住院时间（LOS）的预测因素，并评估观察到的住院时间与预测的住院时间之差作为住院治疗低效率指标的性能。
对1999年古巴哈瓦那“阿梅吉拉斯兄弟”综合医院精神科出院患者进行回顾性病例系列研究。374份符合条件的病历被随机分为两组，每组187份。我们在第一组中推导了估计预测住院时间的函数。可能的预测因素包括：年龄、性别、居住地点、诊断、是否使用电休克治疗、合并症、入院时的症状、用药情况、婚姻状况以及对治疗的反应。住院时间是因变量。对患者病历进行全面检查是评估该函数在第二组中检测低效率问题能力的基础。
该函数解释了住院时间变化的37%。对住院时间影响最大的因素有：年龄（p = 0.002）、对治疗的反应（p < 0.0001）、人格障碍虚拟变量（p = 0.01）、电休克治疗（p = 0.003）、性和/或饮食症状因素（p = 0.003）以及精神病症状因素（p = 0.025）。护理效率低下的病历组的平均观察住院时间比预测值高2天，而护理效率可接受的病历组的观察平均住院时间比预测值低4天。检测低效率的ROC曲线下面积为69%。
本研究证明了急性护理精神科中住院时间可能预测因素的重要性。所提出的指标可轻松用于检测低效率情况。
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