Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
J Gen Intern Med. 2010 Sep;25(9):930-5. doi: 10.1007/s11606-010-1370-5. Epub 2010 Apr 29.
Length of stay at US acute care hospitals has been steadily decreasing since 1960, and there is ongoing concern that increasing financial pressures on hospitals with high proportions of Medicaid patients may be causing unduly short lengths of stay.
To study temporal trends in hospital utilization on internal medicine services at Temple University Hospital, which has the highest percentage of Medicaid and uninsured patients in the state of Pennsylvania.
Examination of temporal changes in hospital practice over three time periods spanning 13 years.
Numbers of discharges, 1- and 12-month re-admission rates, and lengths of stay. US census data from 1990 to 2000 were examined for the eight major zip codes in which hospitalized patients live.
The number of internal medicine admissions increased from 1991 (117/month) to 2004 (455/month); p < 0.0001. Mean length of stay for the index admission decreased from 8.7 to 4.9 days; p < 0.001. The percentage of patients readmitted within 12 months of the discharge date of the index admission increased from 42.3% to 49.5%; p = 0.045. Mean cumulative length of stay over 12 months, including readmissions, decreased significantly (15.8 to 12.5 days; p = 0.031). Compared to all US hospitals, our hospital had a greater increase in admissions and a greater decrease in length of stay. During this time period, in surrounding zip codes, there were decreases in total population and total number of persons living in poverty, but also multiple closures of area hospitals that served poor patients.
During the 13-year study period, despite increased readmission rates, the overall number of hospitalized days per year on the internal medicine inpatient service decreased. As local hospitals serving this inner city low income area have closed, our hospital had atypically high increases in numbers of admissions and decreases in length of stay. This raises questions about current adequacy of hospital care in inner city areas of poverty.
自 1960 年以来，美国急性护理医院的住院时间一直在稳步缩短，人们持续关注的是，医疗补助计划患者比例较高的医院面临的财务压力不断增加，可能导致住院时间过短。
研究天普大学医院内科服务的医院利用情况的时间趋势，该医院是宾夕法尼亚州拥有医疗补助计划和无保险患者比例最高的医院。
考察三个时间段内 13 年来医院实践的变化。
出院人数、1 个月和 12 个月再入院率以及住院时间。检查了 1990 年至 2000 年美国人口普查数据中住院患者居住的八个主要邮政编码。
内科入院人数从 1991 年（117/月）增加到 2004 年（455/月）；p<0.0001。索引入院的平均住院时间从 8.7 天减少到 4.9 天；p<0.001。出院后 12 个月内再入院的患者比例从 42.3%增加到 49.5%；p=0.045。包括再入院在内的 12 个月内累计住院时间显著减少（从 15.8 天减少到 12.5 天；p=0.031）。与所有美国医院相比，我们医院的入院人数增加更多，住院时间减少更多。在此期间，在周边邮政编码地区，总人口和贫困人口数量减少，但也有多家为贫困患者服务的地区医院关闭。
在 13 年的研究期间，尽管再入院率有所增加，但内科住院服务每年的住院总天数仍有所减少。随着为这个城市贫困地区服务的当地医院关闭，我们医院的入院人数异常增加，住院时间缩短。这引发了关于城市贫困地区医院护理当前是否充足的问题。
