Satjapot Siriporn Patricia, Johnson Tricia J, Garman Andrew N
Operations Integration, Johns Hopkins Health System, Baltimore, Maryland 21287, USA.
Qual Manag Health Care. 2011 Jan-Mar;20(1):76-83. doi: 10.1097/QMH.0b013e318203a0ab.
In this study, we assess whether length of stay (LOS) is associated with patient geographic origin and whether payment source for international patients explains differences in LOS.
We used a retrospective case-control study to compare inbound international patients coming to the United States and domestic patients, who were admitted to academic medical centers (AMCs) between October 2005 and September 2008. International patients were matched to domestic patients on the basis of age, gender, AMC, admission status, severity of illness (SOI), and Medicare Severity Diagnosis-Related Group.
International patients stayed significantly longer than domestic patients, with an average LOS of 6.9 days (SD = 14.0) compared with 6.0 days (SD = 5.3) for domestic patients (P < .001). There was no difference in LOS between patients with international commercial and international self-pay payment sources (P = .108). Results of the multivariate analysis showed that international patients with extreme SOI stayed 21% longer than otherwise similar domestic patients with extreme SOI (P = .012).
The most complex international patients coming to US AMCs have substantially longer LOS than the most complex domestic patients, even after controlling for demographic characteristics, and type of condition. More research is needed to understand the underlying drivers of these differences.
在本研究中，我们评估住院时间（LOS）是否与患者的地理来源相关，以及国际患者的支付来源是否能解释住院时间的差异。
我们采用回顾性病例对照研究，比较2005年10月至2008年9月期间入住学术医疗中心（AMC）的赴美国际患者和国内患者。国际患者根据年龄、性别、AMC、入院状态、疾病严重程度（SOI）和医疗保险严重程度诊断相关组与国内患者进行匹配。
国际患者的住院时间显著长于国内患者，国际患者的平均住院时间为6.9天（标准差=14.0），而国内患者为6.0天（标准差=5.3）（P<.001）。国际商业支付来源和国际自费支付来源的患者住院时间没有差异（P=.108）。多变量分析结果显示，SOI极高的国际患者比SOI极高的类似国内患者住院时间长21%（P=.012）。
即使在控制了人口统计学特征和病情类型之后，前往美国AMC的最复杂国际患者的住院时间仍比最复杂的国内患者长得多。需要更多研究来了解这些差异的潜在驱动因素。
