Testi A, Tanfani E, Valente R, Ansaldo G L, Torre G C
Department of Economics and Quantitative Methods, University of Genova, Genova, Italy.
J Eval Clin Pract. 2008 Feb;14(1):59-64. doi: 10.1111/j.1365-2753.2007.00794.x.
RATIONALE, AIMS AND OBJECTIVES: This paper deals with the problem of surgical waiting lists and is aimed, in particular, at comparing two different prioritization approaches: (1) the clinical assessment of treatment urgency aimed at categorizing patients into urgency-related groups (URGs) with a given recommended maximum waiting time for treatment; and (2) the implementation of an original prioritization scoring algorithm aimed at determining the relative priority of each patient in the waiting list and the corresponding order of admission.
A modelling exercise based on a cohort of 236 patients enrolled on the waiting list of a surgical department in an Italian public university hospital, from 1 January to 30 June 2004, is presented. The comparison is based on a measure called need-adjusted-waiting-days, which allows to take into proper account both urgency and priority.
The results show that both methods should be implemented simultaneously for increasing the department's performance in terms of both efficiency--outcome gained from a given amount of resources--and equity--how patients are admitted according to their need.
Waiting list prioritization should not be limited to classifying patients into URGs, but to using a scoring system as well, in order to schedule patient admissions in an explicit and transparent way.
基本原理、目的和目标：本文探讨手术等候名单的问题，尤其旨在比较两种不同的优先排序方法：（1）对治疗紧迫性进行临床评估，目的是将患者分类到与紧迫性相关的组（URGs）中，并给定推荐的最长治疗等待时间；（2）实施一种原始的优先排序评分算法，目的是确定等候名单上每个患者的相对优先级以及相应的入院顺序。
介绍了一项基于2004年1月1日至6月30日在意大利一所公立大学医院外科等候名单上登记的236名患者队列的建模练习。比较基于一种称为需求调整等待天数的度量，该度量能够适当兼顾紧迫性和优先级。
结果表明，两种方法应同时实施，以提高科室在效率（从给定数量资源中获得的结果）和公平性（患者如何根据需求入院）方面的表现。
等候名单的优先排序不应仅限于将患者分类到URGs中，还应使用评分系统，以便以明确和透明的方式安排患者入院。
