Weissman J S, Stern R, Fielding S L, Epstein A M
Brigham and Women's Hospital, Boston, Massachusetts.
Ann Intern Med. 1991 Feb 15;114(4):325-31. doi: 10.7326/0003-4819-114-4-325.
To determine characteristics of patients reporting delays in care before hospitalization and the reasons for those delays.
Survey; personal interviews.
Five hospitals in Massachusetts.
Subjects were drawn from a consecutive sample of all adult patients (excluding obstetrics or psychiatry patients) hospitalized during the first 6 months of 1987 as part of a larger study of hospital costs. For the current study, if patients were re-admitted, we included in our analysis only data on the first admission during the study period. We obtained usable survey data from 12,068 of 17,231 eligible patients.
Delays in care were reported by 16% of patients. The odds of reporting delays in care among patients who were black, poor, uninsured, or without a regular physician were 40% to 80% greater than those for other patients (P less than 0.01). Most patients who reported delays thought that their problem was not serious (64%). Cost was an important factor in delaying care for patients in lower socioeconomic positions; the odds of delaying care because of cost for patients who were both poor and uninsured were 12 times greater than the odds for other patients (P less than 0.001). After controlling for diagnosis-related groups (DRGs) and severity, patients who reported delays had 9% longer hospital stays compared with others (P less than 0.001).
Patients generally thought to be disadvantaged are at especially high risk for delaying care for conditions that eventually lead to hospitalization. Because these delays are associated with longer hospital stays and potentially poorer health outcomes, interventions that reduce delays seem especially important.
确定报告住院前护理延误情况的患者特征及其延误原因。
调查；个人访谈。
马萨诸塞州的五家医院。
研究对象来自1987年上半年住院的所有成年患者（不包括产科或精神科患者）的连续样本，这是一项关于医院成本的大型研究的一部分。对于本研究，如果患者再次入院，我们仅将研究期间首次入院的数据纳入分析。我们从17231名符合条件的患者中获得了12068份可用的调查数据。
16%的患者报告存在护理延误。黑人、贫困、未参保或没有固定医生的患者报告护理延误的几率比其他患者高40%至80%（P<0.01）。大多数报告延误的患者认为他们的问题不严重（64%）。成本是社会经济地位较低的患者延误护理的一个重要因素；贫困且未参保的患者因成本而延误护理的几率是其他患者的12倍（P<0.001）。在控制了诊断相关组（DRGs）和病情严重程度后，报告延误的患者住院时间比其他患者长9%（P<0.001）。
通常被认为处于不利地位的患者在延误最终导致住院的疾病护理方面风险尤其高。由于这些延误与更长的住院时间以及潜在的更差健康结果相关，减少延误的干预措施似乎尤为重要。
