Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK.
Department of Physiology, Anatomy and Genetics, University of Oxford, UK.
Gerontologist. 2019 Mar 14;59(2):e86-e97. doi: 10.1093/geront/gnx028.
To determine the prevalence of delayed discharges of elderly inpatients and associated costs.
We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals. Descriptive and regression analyses were conducted. Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed. Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP).
Of 64 studies included, 52 (81.3%) reported delayed discharges as proportions of total hospital stay and 9 (14.1%) estimated the respective costs for these delays. Proportions of delayed discharges varied widely, from 1.6% to 91.3% with a weighted mean of 22.8%. This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 1.6% and 60.0%. No factor was found to be significantly associated with delays. The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient.
Delayed discharges occur in most countries and the associated costs are significant. However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges. A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays.
确定老年住院患者延迟出院的发生率及其相关费用。
我们检索了 Medline、Embase、Global Health、CAB Abstracts、Econlit、Web of Knowledge、EBSCO-CINAHL、The Cochrane Library、Health Management Information Consortium 和 SCIE-Social Care Online，以获取 1990 年至 2015 年间关于急性医院老年住院患者延迟出院天数或比例的研究证据。进行描述性和回归分析。使用随机效应逻辑模型对延迟出院的比例数据进行汇总，并评估相关因素的关联。以购买力平价（PPP）调整后的美元计算延迟出院的平均费用。
在纳入的 64 项研究中，有 52 项（81.3%）报告了延迟出院的比例，9 项（14.1%）估计了这些延迟的相应费用。延迟出院的比例差异很大，从 1.6%到 91.3%，加权平均值为 22.8%。这种差异也存在于来自同一国家的研究中，例如，在英国，范围从 1.6%到 60.0%。没有发现任何因素与延迟显著相关。延迟出院的平均费用也差异很大（调整后为 142 至 31935 美元 PPP），反映了每位患者平均延迟天数的可变性。
延迟出院在大多数国家都很常见，相关费用也很高。然而，延迟出院的发生率和可用成本数据的差异限制了我们对延迟出院全面影响的了解。需要对方法进行标准化，以允许进行比较，并需要进行更多的研究——最好按疾病领域进行——以确定特定患者群体的出院后需求和延迟的估计成本。
