Kjekshus Lars Erik
SINTEF Health Research, Oslo and Faculty of Medicine, University of Oslo, Department of Health Management and Health Economics, Health Management Research Program Norway (HORN), Oslo, Norway.
Scand J Public Health. 2005;33(2):114-22. doi: 10.1080/14034940410019163.
Norwegian healthcare services are divided between primary and secondary care providers. A growing problem is that every third patient of 75 years of age or more experiences an extended stay in a somatic hospital while waiting to be sent to primary healthcare services. The interaction between these two levels of healthcare services is analysed to examine the effect on a patient's length of stay in hospital.
Recent studies have asserted that research on length of stay in hospital should include influential factors such as system variation and system characteristics, in addition to standardizing for case-mix. New organizational routines are identified in 50 Norwegian somatic hospitals. A multivariate linear regression is used in both a static and a dynamic model to explain variations in hospital length of stay and in additional length of stay (5% of stays are defined as outliers).
The study shows that newly specialized structures constructed to enhance the interaction between the two levels have had no effect. Length of stay is dependent on the capacity of the primary healthcare provider and on the share of elderly in the hospital catchment area, the type of patients, the procedure performed, and the characteristics of the hospital.
Variation in length of stay between hospitals is primarily explained by the capacity of primary healthcare providers. However, some support is found in the dynamic model that introduces the proposition that a hospital-owned hotel would decrease the length of stay of patients in hospital.
挪威的医疗服务由初级和二级医疗服务提供者分担。一个日益严重的问题是，每三名75岁及以上的患者中就有一人在等待转至初级医疗服务机构期间在综合医院延长住院时间。分析这两个医疗服务层面之间的相互作用，以研究其对患者住院时间的影响。
近期研究表明，除了对病例组合进行标准化外，关于住院时间的研究还应包括系统变异和系统特征等影响因素。在50家挪威综合医院中识别出新的组织常规。在静态和动态模型中均使用多元线性回归来解释住院时间和额外住院时间的变异（5%的住院时间被定义为异常值）。
研究表明，为加强两个层面之间的相互作用而新建的专业化结构没有效果。住院时间取决于初级医疗服务提供者的能力、医院服务区域内老年人的比例、患者类型、所进行的手术以及医院的特征。
医院之间住院时间的差异主要由初级医疗服务提供者的能力来解释。然而，在引入医院自有酒店会缩短患者住院时间这一命题的动态模型中发现了一些支持证据。
