DeRienzo C, Kohler J A, Lada E, Meanor P, Tanaka D
Mission Health System, Administration, Asheville, NC, USA.
Mission Children's Specialists, Asheville, NC, USA.
J Perinatol. 2016 Dec;36(12):1128-1131. doi: 10.1038/jp.2016.128. Epub 2016 Sep 1.
Health-care leaders place significant focus on reducing the average length of stay (ALOS). We examined the relationships among ALOS, cost and clinical outcomes using a neonatal intensive care unit (NICU) simulation model.
A discrete-event NICU simulation model based on the Duke NICU was created. To identify the relationships among ALOS, cost and clinical outcomes, we replaced the standard probability distributions with composite distributions representing the best and worst outcomes published by the National Institutes of Health Neonatal Research Network.
Both average cost per patient and average cost per ⩽28 week patient were lower in the best NICU ($16,400 vs $19,700 and $56,800 vs $76,700, respectively), while LOS remained higher (27 vs 24 days).
Our model demonstrates that reducing LOS does not uniformly reduce hospital resource utilization. These results suggest that health-care leaders should not simply rely on initiatives to reduce LOS without clear line-of-sight on clinical outcomes as well.
医疗保健领导者高度重视缩短平均住院时间（ALOS）。我们使用新生儿重症监护病房（NICU）模拟模型研究了ALOS、成本和临床结果之间的关系。
基于杜克新生儿重症监护病房创建了一个离散事件新生儿重症监护病房模拟模型。为了确定ALOS、成本和临床结果之间的关系，我们用代表美国国立卫生研究院新生儿研究网络公布的最佳和最差结果的复合分布取代了标准概率分布。
最佳新生儿重症监护病房中每位患者的平均成本和每位孕周≤28周患者的平均成本均较低（分别为16,400美元对19,700美元和56,800美元对76,700美元），而住院时间仍然较长（27天对24天）。
我们的模型表明，缩短住院时间并不会一致地降低医院资源利用率。这些结果表明，医疗保健领导者不应仅仅依赖于缩短住院时间的举措，而对临床结果没有清晰的预见。
