Unrath M, Kalic M, Berger K
Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster.
Dtsch Med Wochenschr. 2012 Aug;137(34-35):1683-8. doi: 10.1055/s-0032-1305213. Epub 2012 Aug 14.
The length of the acute hospital stay (LOS) is an indicator of efficiency in the treatment of ischemic brain infarctions (ICD I63). The aim of this study was to describe the development of the LOS over 10 years and to analyze influencing factors with a focus on the structural level of hospitals.
Routine treatment data for the years 2000 to 2009 generated within the quality assurance project "Stroke Register Northwest Germany" formed the basis of our analyses (n = 175,149). Additionally, the infrastructure and equipment of the hospitals were documented. Information regarding the bed density on county level was provided by the statistical offices of the federal German states. The median LOS was calculated for each year. Moreover, a linear multilevel analysis of the influencing factors stratified by hospital specialty was performed.
The LOS after an ischemic brain infarction decreased by several days over the years 2000 to 2009. The difference between the specialties neurology vs. internal and geriatric medicine diminished. A small part of variation in LOS was explained by the factors measured on the three levels patient, hospital and county. The biggest proportion of variance was explained by socio-demographic and clinical factors measured on patient level. Hospital equipment contributed somewhat additionally to the explanation of variance for hospitals specializing in internal and geriatric medicine. There were differences between the medical specialties both with regard to the associations observed and the distribution of variance on the three levels.
There was a reduction of the LOS in patients with ischemic brain infarction. A stratified analysis according to medical specialty seems necessary. Single features of the hospital infrastructure are associated with the LOS. However, the interpretation of these associations is in part difficult.
急性住院时长（LOS）是缺血性脑梗死（ICD I63）治疗效率的一个指标。本研究的目的是描述10年间住院时长的变化情况，并着重从医院结构层面分析影响因素。
我们的分析基于“德国西北部卒中登记”质量保证项目在2000年至2009年期间生成的常规治疗数据（n = 175,149）。此外，还记录了医院的基础设施和设备情况。德国联邦各州统计局提供了县级床位密度信息。计算每年的中位住院时长。此外，还对按医院专科分层的影响因素进行了线性多水平分析。
在2000年至2009年期间，缺血性脑梗死后的住院时长逐年减少了数天。神经病学与内科及老年医学专科之间的差异缩小。住院时长变异的一小部分可由患者、医院和县级这三个层面所测量的因素解释。变异的最大比例由患者层面所测量的社会人口统计学和临床因素解释。医院设备对内科及老年医学专科医院变异的解释略有贡献。各医学专科在观察到的关联以及三个层面的变异分布方面均存在差异。
缺血性脑梗死患者的住院时长有所缩短。按医学专科进行分层分析似乎很有必要。医院基础设施的单一特征与住院时长相关。然而，对这些关联的解释部分存在困难。
