Douw Karla, Nielsen Camilla Palmhøj, Pedersen Camilla Riis
University of Southern Denmark, Department of Public Health, Winsløwsvej 9b, Odense C, DK-5000 Odense, Denmark.
Public Health and Quality Improvement, Central Denmark Region, Region House Aarhus Olof Palmes Allé 15, Aarhus N, DK-8200 Aarhus, Denmark.
Health Policy. 2015 Aug;119(8):1005-10. doi: 10.1016/j.healthpol.2015.05.007. Epub 2015 Jun 6.
In May 2012, one of Denmark's five health care regions mandated a reform of stroke care. The purpose of the reform was to save costs, while at the same time improving quality of care. It included (1) centralisation of acute stroke treatment at specialised hospitals, (2) a reduced length of hospital stay, and (3) a shift from inpatient rehabilitation programmes to community-based rehabilitation programmes. Patients would benefit from a more integrated care pathway between hospital and municipality, being supported by early discharge teams at hospitals. A formal policy tool, consisting of a health care agreement between the region and municipalities, was used to implement the changes. The implementation was carried out in a top-down manner by a committee, in which the hospital sector--organised by regions--was better represented than the primary care sector-organised by municipalities. The idea of centralisation of acute care was supported by all stakeholders, but municipalities opposed the hospital-based early discharge teams as they perceived this to be interfering with their core tasks. Municipalities would have liked more influence on the design of the reform. Preliminary data suggest good quality of acute care. Cost savings have been achieved in the region by means of closure of beds and a reduction of hospital length of stay. The realisation of the objective of achieving integrated rehabilitation care between hospitals and municipalities has been less successful. It is likely that greater involvement of municipalities in the design phase and better representation of health care professionals in all phases would have led to more successful implementation of the reform.
2012年5月，丹麦五个医疗保健区域之一授权对中风护理进行改革。改革的目的是在节约成本的同时提高护理质量。改革内容包括：（1）将急性中风治疗集中在专科医院；（2）缩短住院时间；（3）从住院康复项目转向社区康复项目。患者将受益于医院与市政当局之间更综合的护理路径，并得到医院早期出院团队的支持。一项正式的政策工具，即该区域与市政当局之间的医疗保健协议，被用于实施这些变革。实施工作由一个委员会自上而下进行，在该委员会中，由区域组织的医院部门比由市政当局组织的初级保健部门有更好的代表性。急性护理集中化的想法得到了所有利益相关者的支持，但市政当局反对以医院为基础的早期出院团队，因为他们认为这干扰了他们的核心任务。市政当局希望在改革设计方面有更大的影响力。初步数据表明急性护理质量良好。该区域通过关闭病床和缩短住院时间实现了成本节约。在实现医院与市政当局之间综合康复护理目标方面则不太成功。市政当局在设计阶段更多地参与以及医疗保健专业人员在所有阶段有更好的代表性，可能会使改革实施得更加成功。
