Koné Insa, Zimmermann Bettina, Wangmo Tenzin, Richner Silvia, Weber Markus, Elger Bernice
Institute of Biomedical Ethics, University of Basel, Switzerland.
Department of Internal Medicine, Central City Hospital Triemli of Zurich, Switzerland.
Swiss Med Wkly. 2018 Jan 16;148:w14575. doi: 10.4414/smw.2018.14575. eCollection 2018.
Switzerland introduced the SwissDRG in 2012. The goal of this reimbursement system was to promote cost containment and efficiency in hospital care. To ensure that patients with care needs are not released prematurely because of constraints under the new hospital financing system, the Swiss law on Acute and Transitional Care (ATC) was introduced one year earlier. The objective of the present study was to investigate the impact of ATC and its effects on discharge of patients with persisting care needs after hospitalisation.
Social service workers, nurses and palliative care team members at a Swiss municipal hospital were asked to complete a four-page closed-ended questionnaire about patients who require care after their hospital discharge. This included questions on discharge management, their perceptions of the appropriateness of discharge timing and details about conflicts regarding discharge. Information on length of stay, discharge location, age and sex was extracted from hospital records and matched to the information from the questionnaires. Demographic data are presented descriptively, differences between patients released to ATC and patients released elsewhere (home, nursing home, rehabilitation, etc.) were evaluated with chi-square tests. Logistic regression analyses were performed to evaluate differences between those sent to ATC and rehabilitation with age, length of stay and sex as predictors.
A total 1410 of valid questionnaires were collected, comprised of 746 female patients (52.9%) and 664 male patients (47.1%). The mean age of our patient cohort was 73.2 years (SD 15.1), and the mean hospital stay was 12.8 days (SD 9.1). After their hospital stay, 553 patients (39.2%) returned home either alone, or with the help of family members or Spitex. More than a quarter of the sample, 387 (27.4%) patients, was sent to rehabilitation. Less than a fifth, 199 (14.1%) patients, received ATC in an inpatient institution (e.g., nursing home). Compared with patients released elsewhere, significantly more problems/conflicts with regard to hospital discharge were reported for ATC patients (28.6 vs 20.6%, p = 0.01) and their relatives (12.6 vs 7.2%, p = 0.01). Women had a higher probability of being discharged to ATC (OR 1.522, p = 0.014) and a lower chance of receiving rehabilitation upon discharge (OR 0.733, p = 0.014).
The study identified important concerns related to receiving ATC after a hospital stay, that is, more problems/conflicts occur with patients discharged to ATC and that the introduction of ATC might particularly disadvantage female patients, who are less likely to receive rehabilitation care.
瑞士于2012年引入了瑞士诊断相关分组（SwissDRG）。这个报销系统的目标是促进医院护理的成本控制和效率提升。为确保有护理需求的患者不会因新的医院融资系统的限制而过早出院，瑞士在一年前出台了关于急性和过渡性护理（ATC）的法律。本研究的目的是调查ATC的影响及其对住院后仍有持续护理需求患者出院的作用。
瑞士一家市立医院的社会服务工作者、护士和姑息治疗团队成员被要求填写一份关于出院后需要护理患者的四页封闭式问卷。这包括关于出院管理、他们对出院时间适宜性的看法以及关于出院冲突的细节等问题。从医院记录中提取住院时间、出院地点、年龄和性别的信息，并与问卷中的信息进行匹配。人口统计学数据采用描述性呈现，使用卡方检验评估转至ATC的患者与转至其他地方（家中、养老院、康复机构等）的患者之间的差异。进行逻辑回归分析，以年龄、住院时间和性别作为预测因素，评估转至ATC和康复机构的患者之间的差异。
共收集到1410份有效问卷，其中女性患者746例（52.9%），男性患者664例（47.1%）。我们患者队列的平均年龄为73.2岁（标准差15.1），平均住院时间为12.8天（标准差9.1）。住院后，553例患者（39.2%）独自或在家人或居家护理服务的帮助下回家。超过四分之一的样本，即387例（27.4%）患者被送去康复。不到五分之一，即199例（14.1%）患者在住院机构（如养老院）接受ATC。与转至其他地方的患者相比，ATC患者（28.6%对20.6%，p = 0.01）及其亲属（12.6%对7.2%，p = 0.01）报告的出院问题/冲突明显更多。女性被转至ATC的概率更高（比值比1.522，p = 0.
