Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
Health Policy. 2013 Jun;111(1):60-7. doi: 10.1016/j.healthpol.2013.03.014. Epub 2013 Apr 28.
To analyze possible factors associated with prolonged length of stay (LOS) in hip fracture patients in Japan, such as the availability of beds in medical and nursing care facilities at the community level, as well as patient factors, clinical factors and hospital structural characteristics.
The sample for analysis consisted of 8318 hip fracture cases from 199 hospitals throughout Japan. We conducted multilevel analyses to investigate whether LOS and the discharge destinations of patients are associated with the availability and utilization of medical and nursing care resources in the communities where each hospital is located.
After adjusting for patient factors, clinical factors and hospital structural characteristics, a higher number of long-term care beds at the community level was observed to be significantly correlated with both shorter LOS and increased rate of discharge to other facilities.
Although the Japanese government is attempting to reduce acute care hospital LOS and the number of long-term care beds in order to reduce health care costs, the results of this study suggest that a reduction in the number of long-term care beds would not necessarily reduce the LOS of acute care hospitals, and may instead exacerbate the problem.
分析与日本髋部骨折患者住院时间延长（LOS）相关的可能因素，例如社区医疗和护理设施床位的可用性，以及患者因素、临床因素和医院结构特征。
本分析的样本包括来自日本 199 家医院的 8318 例髋部骨折病例。我们进行了多水平分析，以调查 LOS 和患者出院去向是否与每个医院所在地社区医疗和护理资源的可用性和利用情况相关。
在调整了患者因素、临床因素和医院结构特征后，社区水平上长期护理床位数量较多与 LOS 缩短和其他设施出院率增加显著相关。
尽管日本政府试图通过减少急性护理医院 LOS 和长期护理床位数量来降低医疗保健成本，但本研究结果表明，减少长期护理床位数量不一定会缩短急性护理医院的 LOS，反而可能会使问题恶化。
