影响医院高住院日离群值的因素。
Factors influencing hospital high length of stay outliers.
机构信息
CINTESIS-Center for Research in Health Technologies and Information Systems, CINTESIS, Portugal.
出版信息
BMC Health Serv Res. 2012 Aug 20;12:265. doi: 10.1186/1472-6963-12-265.
BACKGROUND
The study of length of stay (LOS) outliers is important for the management and financing of hospitals. Our aim was to study variables associated with high LOS outliers and their evolution over time.
METHODS
We used hospital administrative data from inpatient episodes in public acute care hospitals in the Portuguese National Health Service (NHS), with discharges between years 2000 and 2009, together with some hospital characteristics. The dependent variable, LOS outliers, was calculated for each diagnosis related group (DRG) using a trim point defined for each year by the geometric mean plus two standard deviations. Hospitals were classified on the basis of administrative, economic and teaching characteristics. We also studied the influence of comorbidities and readmissions. Logistic regression models, including a multivariable logistic regression, were used in the analysis. All the logistic regressions were fitted using generalized estimating equations (GEE).
RESULTS
In near nine million inpatient episodes analysed we found a proportion of 3.9% high LOS outliers, accounting for 19.2% of total inpatient days. The number of hospital patient discharges increased between years 2000 and 2005 and slightly decreased after that. The proportion of outliers ranged between the lowest value of 3.6% (in years 2001 and 2002) and the highest value of 4.3% in 2009. Teaching hospitals with over 1,000 beds have significantly more outliers than other hospitals, even after adjustment to readmissions and several patient characteristics.
CONCLUSIONS
In the last years both average LOS and high LOS outliers are increasing in Portuguese NHS hospitals. As high LOS outliers represent an important proportion in the total inpatient days, this should be seen as an important alert for the management of hospitals and for national health policies. As expected, age, type of admission, and hospital type were significantly associated with high LOS outliers. The proportion of high outliers does not seem to be related to their financial coverage; they should be studied in order to highlight areas for further investigation. The increasing complexity of both hospitals and patients may be the single most important determinant of high LOS outliers and must therefore be taken into account by health managers when considering hospital costs.
背景
住院时间（LOS）异常值的研究对于医院的管理和融资非常重要。我们的目的是研究与高 LOS 异常值相关的变量及其随时间的演变。
方法
我们使用了葡萄牙国家卫生服务（NHS）中公立急性保健医院的住院患者行政数据，出院时间为 2000 年至 2009 年，同时还使用了一些医院特征。每个诊断相关组（DRG）的 LOS 异常值是通过为每个年份定义的几何平均值加两个标准差的修剪点来计算的。医院根据行政、经济和教学特征进行分类。我们还研究了合并症和再入院的影响。使用逻辑回归模型，包括多变量逻辑回归，进行分析。所有逻辑回归均使用广义估计方程（GEE）拟合。
结果
在近 900 万次住院患者分析中，我们发现高 LOS 异常值的比例为 3.9%，占总住院天数的 19.2%。医院患者出院人数在 2000 年至 2005 年间增加，此后略有减少。异常值的比例在最低值 3.6%（2001 年和 2002 年）和最高值 4.3%（2009 年）之间波动。床位超过 1000 张的教学医院的异常值明显多于其他医院，即使在调整再入院和多个患者特征后也是如此。
结论
在过去几年中，葡萄牙 NHS 医院的平均 LOS 和高 LOS 异常值都在增加。由于高 LOS 异常值在总住院天数中占重要比例，因此这应被视为医院管理和国家卫生政策的重要警示。正如预期的那样，年龄、入院类型和医院类型与高 LOS 异常值显著相关。高异常值的比例似乎与它们的财务覆盖范围无关；应进一步研究它们，以突出进一步调查的领域。医院和患者的复杂性不断增加可能是 LOS 异常值的唯一最重要决定因素，因此，卫生管理人员在考虑医院成本时应考虑这一点。
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