细支气管炎临床路径依从性与住院时间及费用的关联。

Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs.

作者信息

Bryan Mersine A, Desai Arti D, Wilson Lauren, Wright Davene R, Mangione-Smith Rita

机构信息

Department of Pediatrics, University of Washington, Seattle, Washington; and

Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.

出版信息

Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-3432. Epub 2017 Feb 9.

DOI:10.1542/peds.2016-3432

PMID:28183732

Abstract

OBJECTIVES

To examine the associations between the level of adherence to bronchiolitis clinical pathway recommendations, health care use, and costs.

METHODS

We conducted a retrospective cohort study of 267 patients ≤24 months old diagnosed with bronchiolitis from 12/2009 to 7/2012. Clinical pathway adherence was assessed by using a standardized scoring system (0-100) for 18 quality measures obtained by medical record review. Level of adherence was categorized into low, middle, and high tertiles. Generalized linear models were used to examine relationships between adherence tertile and (1) length of stay (LOS) and (2) costs. Logistic regression was used to examine the associations between adherence tertile and probability of inpatient admission and 7-day readmissions.

RESULTS

Mean adherence scores were: ED, 78.8 (SD, 18.1; = 264), inpatient, 95.0 (SD, 6.3; = 216), and combined ED/inpatient, 89.1 (SD, 8.1; = 213). LOS was significantly shorter for cases in the highest versus the lowest adherence tertile (ED, 90 vs 140 minutes, adjusted difference, -51 [95% confidence interval (CI), -73 to -29; <.05]; inpatient, 3.1 vs 3.8 days, adjusted difference, -0.7 [95% CI, -1.4 to 0.0; <.05]). Costs were less for cases in the highest adherence tertile (ED, -$84, [95% CI, -$7 to -$161; <.05], total, -$1296 [95% CI, -126.43 to -2466.03; <.05]). ED cases in the highest tertile had a lower odds of admission (odds ratio, 0.38 [95% CI, 0.15-0.97; < .05]). Readmissions did not differ by tertile.

CONCLUSIONS

High adherence to bronchiolitis clinical pathway recommendations across care settings was associated with shorter LOS and lower cost.

摘要

目的

探讨毛细支气管炎临床路径建议的依从水平、医疗保健利用情况和成本之间的关联。

方法

我们对2009年12月至2012年7月期间诊断为毛细支气管炎的267例24个月及以下的患者进行了一项回顾性队列研究。通过使用标准化评分系统（0 - 100）对通过病历审查获得的18项质量指标进行评估，以确定临床路径的依从性。依从水平分为低、中、高三分位数。使用广义线性模型来研究依从三分位数与（1）住院时间（LOS）和（2）成本之间的关系。使用逻辑回归来研究依从三分位数与住院入院概率和7天再入院率之间的关联。

结果

平均依从性得分分别为：急诊科，78.8（标准差，18.1；n = 264），住院部，95.0（标准差，6.3；n = 216），以及急诊科/住院部综合，89.1（标准差，8.1；n = 213）。依从性最高三分位数组与最低三分位数组相比，住院时间显著缩短（急诊科，90分钟对140分钟，调整差异，-51[95%置信区间（CI），-73至-29；P <.05]；住院部，3.1天对3.8天，调整差异，-0.7[95% CI，-1.4至0.0；P <.05]）。依从性最高三分位数组的成本较低（急诊科，-$84，[95% CI，-$7至-$161；P <.05]，总计，-$1296[95% CI，-126.43至-2466.03；P <.05]）。最高三分位数组的急诊科病例入院几率较低（优势比，0.38[95% CI，0.15 - 0.97；P <.05]）。再入院率在三分位数之间没有差异。