Bindman A B, Keane D, Lurie N
Department of Medicine, San Francisco General Hospital, CA 94110.
JAMA. 1990 Dec 12;264(22):2899-904. doi: 10.1001/jama.264.22.2899.
We studied the impact of the closing of a public hospital on patients' access to care and health status. We surveyed individuals who had been medical inpatients at Shasta General Hospital, Redding, Calif, in the year prior to its closing and compared them with those in a second county, San Luis Obispo, whose public hospital did not close. Surveys were administered after the closing of Shasta General Hospital and 1 year later. We assessed outcomes using the Medical Outcomes Study Short Form and a series of transition questions that asked about changes in health over time. Data were available for 88% of patients at 1 year: 219 from Shasta County and 195 from San Luis Obispo County. At follow-up, the percentage of patients from Shasta County who reported no regular provider increased from 14.0 to 27.7 and the percentage who reported they were denied care rose from 10.8 to 16.9. Meanwhile, patients in San Luis Obispo County reported improved access to a regular provider and the level of denied care was unchanged. Patients in Shasta County had significant declines on the Medical Outcomes Study Short Form in health perception, social and role function, and increases in pain as compared with those patients in San Luis Obispo County. The closing of a public hospital had a significant effect on access to health care and was associated with a decline in health status.
我们研究了一家公立医院关闭对患者获得医疗服务的机会和健康状况的影响。我们对加利福尼亚州雷丁市沙斯塔综合医院关闭前一年内在该院住院治疗的患者进行了调查，并将他们与第二个县圣路易斯奥比斯波县的患者进行比较，该县的公立医院没有关闭。在沙斯塔综合医院关闭后及一年后进行了调查。我们使用医学结果研究简表和一系列询问健康随时间变化情况的过渡性问题来评估结果。一年后，88%的患者有数据可供分析：219名来自沙斯塔县，195名来自圣路易斯奥比斯波县。在随访中，沙斯塔县报告没有固定医疗服务提供者的患者比例从14.0%增至27.7%，报告被拒绝提供医疗服务的患者比例从10.8%升至16.9%。与此同时，圣路易斯奥比斯波县的患者报告称获得固定医疗服务提供者的机会有所改善，被拒绝提供医疗服务的水平没有变化。与圣路易斯奥比斯波县的患者相比，沙斯塔县的患者在医学结果研究简表中的健康感知、社会和角色功能方面显著下降，疼痛加剧。一家公立医院的关闭对获得医疗服务产生了重大影响，并与健康状况下降有关。
