Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville.
Eur Respir J. 2014 Mar;43(3):754-62. doi: 10.1183/09031936.00074413. Epub 2013 Aug 29.
Studies have suggested that larger hospitals have better resources and provide better care than smaller ones. This study aimed to explore the relationship between hospital size, resources, organisation of care and adherence to guidelines. The European COPD Audit was designed as a pilot study of clinical care and a survey of resources and organisation of care. Data were entered by clinicians to a multilingual web tool and analysed centrally. Participating hospitals were divided into tertiles on the basis of bed numbers and comparisons made of the resources, organisation of care and adherence to guidelines across the three size groups. 13 national societies provided data on 425 hospitals. The mean number of beds per tertile was 220 (lower), 479 (middle), and 989 (upper). Large hospitals were more likely to have resources and increased numbers of staff; hospital performance measures were related in a minority of indicators only. Adherence to guidelines also varied with hospital size, but the differences were small and inconsistent. There is a wide variation in the size, resources and organisation of care across Europe for hospitals providing chronic obstructive pulmonary disease care. While larger hospitals have more resources, this does not always equate to better accessibility or quality of care for patients.
研究表明，大型医院比小型医院拥有更好的资源，并提供更好的护理。本研究旨在探讨医院规模、资源、护理组织与遵循指南之间的关系。欧洲 COPD 审核被设计为临床护理的试点研究和资源与护理组织的调查。临床医生通过多语言网络工具输入数据，并进行集中分析。根据床位数将参与医院分为三组，比较三组之间的资源、护理组织和遵循指南的情况。13 个国家协会提供了 425 家医院的数据。每三分位组的平均床位数分别为 220（低位）、479（中位）和 989（高位）。大型医院拥有更多的资源和更多的员工；只有少数指标的医院绩效测量结果相关。遵循指南的情况也因医院规模而异，但差异较小且不一致。为慢性阻塞性肺疾病患者提供护理的欧洲医院在规模、资源和护理组织方面存在广泛差异。虽然大型医院拥有更多的资源，但这并不一定意味着患者能够获得更好的可及性或护理质量。
