Straubhaar Katrin, Schuetz Philipp, Blum Claudine Angela, Nigro Nicole, Briel Matthias, Christ-Crain Mirjam, Mueller Beat
Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Switzerland.
Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Switzerland; Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and.
Swiss Med Wkly. 2016 Sep 29;146:w14337. doi: 10.4414/smw.2016.14337. eCollection 2016.
In-hospital care of patients with community-acquired pneumonia (CAP) varies across hospitals. Understanding of the underlying factors is the basis for tailored quality improvements. Using data from a randomised controlled Swiss-wide multicentre trial, we compared length of stay (LOS) and other patient outcomes according to (A) the use of a procalcitonin (PCT)-based antibiotic stewardship protocol, (B) institution type (university vs non-university), and (C) historical time period in relation to the introduction of Diagnosis Related Group (DRG) reimbursement (2012).
We included 784 patients hospitalised with CAP from six institutions into this secondary analysis. We used multivariable regression models adjusted for age, comorbidities and disease severity to determine the influence of institution characteristics on LOS and patient outcomes.
LOS was significantly shorter in the institution using a PCT-based antibiotic stewardship protocol (9.2 vs 5.3 days; adjusted mean difference 3.92 days; 95% confidence interval [CI] 5.16-2.68) with shorter antibiotic treatment. There was no difference in LOS in university vs non-university hospitals, but antibiotic courses in university-type hospitals were longer (11.0 vs 8.3 days; adjusted mean difference 2.59 days; 95% CI, 1.69-3.49). No significant difference in LOS was found when comparing the time period before and after the introduction of the DRG system in Switzerland.
We found differences in LOS associated with theuse of a PCT-based antibiotic stewardship protocol, which remained robust after multivariable adjustment. Importantly, the type of institution and model of reimbursement did not influence LOS in our CAP cohort. More health services research studies are needed to establish causal effects.
社区获得性肺炎（CAP）患者的院内护理在不同医院存在差异。了解潜在因素是进行针对性质量改进的基础。我们利用一项瑞士范围内的随机对照多中心试验的数据，根据以下因素比较了住院时间（LOS）和其他患者结局：（A）使用基于降钙素原（PCT）的抗生素管理方案；（B）机构类型（大学医院与非大学医院）；（C）与引入诊断相关组（DRG）报销制度（2012年）相关的历史时间段。
我们将来自六个机构的784例因CAP住院的患者纳入这项二次分析。我们使用了针对年龄、合并症和疾病严重程度进行调整的多变量回归模型，以确定机构特征对LOS和患者结局的影响。
使用基于PCT的抗生素管理方案的机构中，LOS显著缩短（9.2天对5.3天；调整后平均差异3.92天；95%置信区间[CI]5.16 - 2.68），抗生素治疗时间也更短。大学医院与非大学医院的LOS没有差异，但大学型医院的抗生素疗程更长（11.0天对8.3天；调整后平均差异2.59天；95%CI，1.69 - 3.49）。比较瑞士引入DRG系统前后的时间段，LOS没有显著差异。
我们发现使用基于PCT的抗生素管理方案与LOS存在差异，在多变量调整后这种差异仍然显著。重要的是，在我们的CAP队列中，机构类型和报销模式并未影响LOS。需要更多的卫生服务研究来确定因果关系。
