Avedis Donabedian Research Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, C/ Provenza, 293, pral., 08037 Barcelona, Spain.
Health Policy. 2010 Dec;98(2-3):107-13. doi: 10.1016/j.healthpol.2010.05.011. Epub 2010 Jun 17.
Cross-border patients have specific quality and safety requirements for hospital care. Little is known to what extent hospitals meet these requirements. We aim to assess their current level, and the factors associated with their implementation.
A cross-sectional survey of 315 hospitals and cardiology departments in the Czech Republic, France, Poland and Spain. Employing bi-variate statistics and logistic regression analysis, we assess quality and safety requirements for cross-border patients and their association with hospital characteristics, cross-border care arrangements, proximity to EU borders, the hospital's quality improvement system, and country.
Certain quality and safety requirements are frequently met (administrative support or informed consent using forms in various EU languages) while others are widely absent (case-managers, contacts to patients' general practitioners). Due to communication problems, it is often not possible to inform patients about their condition and treatment. Discharge summaries are rarely available in other than the vernacular languages, and medication upon discharge and arranging back-transfer occur occasionally only. Logistic regression analysis suggests a strong effect of country-level covariates (followed by type of hospital, hospital size and hospital's quality improvement system), but covariates are not consistently associated with higher rates of implementation. Hospitals with existing cross-border care collaboration do not differ substantially from hospitals without such arrangements.
Cross-border patients have specific quality and safety requirements that are not always met. Various factors are associated with these requirements; however, the trend is not systematic and the underlying mechanisms need to be studied further to inform policy decisions.
跨境患者对医院护理有特定的质量和安全要求。目前尚不清楚医院在多大程度上满足这些要求。我们旨在评估其当前水平，以及与实施相关的因素。
对捷克共和国、法国、波兰和西班牙的 315 家医院和心脏病科进行横断面调查。采用双变量统计和逻辑回归分析，评估跨境患者的质量和安全要求及其与医院特征、跨境护理安排、与欧盟边境的接近程度、医院的质量改进系统以及国家的关系。
某些质量和安全要求经常得到满足（使用各种欧盟语言的表格提供行政支持或知情同意），而其他要求则广泛缺失（个案经理，与患者的全科医生联系）。由于沟通问题，通常无法向患者告知其病情和治疗情况。出院小结除了本国语言外很少提供其他语言，出院时的药物和安排返回转移也很少发生。逻辑回归分析表明，国家层面的协变量（其次是医院类型、医院规模和医院的质量改进系统）有很强的影响，但协变量与更高的实施率并不始终相关。有跨境护理合作的医院与没有此类安排的医院没有显著差异。
跨境患者有特定的质量和安全要求，但这些要求并不总是得到满足。各种因素与这些要求有关；然而，这种趋势并不系统，需要进一步研究潜在机制，为政策决策提供信息。
