Macy Michelle L, Stanley Rachel M, Lozon Marie M, Sasson Comilla, Gebremariam Achamyeleh, Davis Matthew M
University of Michigan, Division of General Pediatrics, 300 N Ingalls, Ann Arbor, MI 48109-5456, USA.
Pediatrics. 2009 Mar;123(3):996-1002. doi: 10.1542/peds.2008-1428.
Brief hospitalizations for children may constitute an opportunity to provide care in an alternative setting such as an observation unit. The goal of this study was to characterize recent national trends in brief inpatient stays for children in the United States.
Using the Nationwide Inpatient Sample from 1993-2003, we analyzed hospital discharges among children <18 years of age, excluding births, deaths, and transfers. Hospitalizations with lengths of stay of 0 and 1 night were designated as "high turnover." Serial cross-sectional analyses were conducted to compare the proportion of high-turnover stays across and within years according to patient and hospital-level characteristics. Diagnosis-related groups and hospital charges associated with these observation-length stays were examined.
In 2003, there were an estimated 441 363 high-turnover hospitalizations compared with 388 701 in 1993. The proportion of high-turnover stays increased from 24.9% in 1993 to 29.9% in 1999 and has remained >/=30.0% since that time. Diagnosis-related groups for high-turnover stays reflect common pediatric medical and surgical conditions requiring hospitalization, including respiratory illness, gastrointestinal/metabolic disorders, seizure/headache, and appendectomy. Significant increases in the proportion of high-turnover stays during the study period were noted across patient and hospital-level characteristics, including age group, payer, hospital location, teaching status, bed size, and admission source. High-turnover stays contributed $1.3 billion (22%) to aggregate hospital charges in 2003, an increase from $494 million (12%) in 1993.
Consistently since 1999, nearly one third of children hospitalized in the United States experience a high-turnover stay. These high-turnover cases constitute hospitalizations, that may be eligible for care in an alternative setting. Observation units provide 1 model for an efficient and cost-effective alternative to inpatient care, in which resources and provider interactions with patients and each other are geared toward shorter stays with more timely discharge processes.
儿童短期住院可能为在诸如观察病房等替代环境中提供护理创造机会。本研究的目的是描述美国近期儿童短期住院的全国趋势。
利用1993年至2003年的全国住院患者样本，我们分析了18岁以下儿童的出院情况，不包括出生、死亡和转院。住院时间为0晚和1晚的住院被指定为“高周转率”。进行系列横断面分析，以根据患者和医院层面的特征比较不同年份和同一年份内高周转率住院的比例。检查与这些观察期住院相关的诊断相关组和医院费用。
2003年，估计有441363例高周转率住院，而1993年为388701例。高周转率住院的比例从1993年的24.9%增加到1999年的29.9%，自那时以来一直保持在≥30.0%。高周转率住院的诊断相关组反映了需要住院治疗的常见儿科医疗和外科疾病，包括呼吸道疾病、胃肠道/代谢紊乱、癫痫/头痛和阑尾切除术。在研究期间，不同患者和医院层面的特征（包括年龄组、付款人、医院位置、教学状况、床位规模和入院来源）的高周转率住院比例均有显著增加。2003年，高周转率住院占医院总费用的13亿美元（22%），高于1993年的4.94亿美元（12%）。
自1999年以来，美国住院儿童中近三分之一经历了高周转率住院。这些高周转率病例构成了住院治疗，可能适合在替代环境中接受护理。观察病房为住院护理提供了一种高效且具成本效益的替代模式，其中资源以及医护人员与患者之间的互动旨在实现更短的住院时间和更及时的出院流程。
