Crippen Cristina J, Hughes Steven J, Chen Sugong, Behrns Kevin E
Department of Surgery, University of Florida, Gainesville, Florida, USA.
Am Surg. 2014 Jul;80(7):690-5.
The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of interhospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients.
绩效薪酬制度的出现给学术医疗中心（AMC）为院际手术转诊患者提供护理的使命带来了风险。本研究调查了大学卫生系统联盟（UHC）和我们外科系（DOS）的这些患者样本的质量指标和资源消耗情况。采用包括死亡率、住院时间（LOS）和成本在内的标准基准，来评估2010年1月至2012年12月期间院际手术转诊患者与直接入院（DA）患者的影响。对于1423893名患者，转诊患者的病例组合指数比DA患者高38%（UHC）和21%（DOS）。转诊患者的死亡率分别为5.70%（UHC）和6.93%（DOS），而DA患者的死亡率分别为1.79%（UHC）和2.93%（DOS）。DA患者的平均住院时间短4天。转诊患者的平均总费用分别比DA患者多13613美元（UHC）和13356美元（DOS）。与DA患者相比，转诊患者的预后较差且消耗更多资源。早期识别和转诊复杂手术患者可能会改善患者救治并减少资源消耗。AMC和社区的外科医生应制定合作项目，以便对复杂手术患者进行集体评估和决策。
