Ricotta Daniel N, Parris James J, Parris Ritika S, Sontag David N, Mukamal Kenneth J
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts, USA.
J Hosp Med. 2018 Sep 1;13(9):595-601. doi: 10.12788/jhm.2946. Epub 2018 Feb 5.
In cases where patients are unable to provide informed consent and have no surrogate decisionmaker, a hospital must seek guardian appointment as a legally recognized surrogate decision-maker.
The aim of this study was to examine the magnitudes of length of stay (LOS) beyond medical clearance and healthcare costs among patients referred for guardianship.
DESIGN, SETTING, PATIENTS: This was a retrospective cohort study of all 61 adult inpatients in a single tertiary care hospital requiring guardianship between October 1, 2014, and September 30, 2015, matched with up to 3 controls from the same discharging services and hospitalized for at least as long as the date of clearance for referred patients.
The following parameters were measured using generalized estimating equations: total LOS, LOS beyond medical clearance (excess LOS), medical complications, and total charges among referred patients, and the LOS and costs were compared with those of matched controls.
Mean LOS for patients requiring guardianship was 31 ± 2 days, and the total charges averaged $179,243 ± 22,950. We documented 12 hospital-acquired complications in 10 (16%; 95% confidence interval [CI], 8%-28%) unique patients. Accounting for potential confounders, the process of obtaining guardianship was associated with a 37% longer total LOS (95% CI [12%- 67%]; P = .002), 58% higher excess LOS (95% CI [2%- 145%]; P = .04), and 23% higher total charges (95% CI [4%-46%]; P = .02).
In this single-center cohort study, the guardianship process was associated with prolonged hospital stay and higher total hospital charges even when compared with matched controls. Furthermore, one in six patients suffered from a hospital-associated complication after medical clearance.
在患者无法提供知情同意且没有替代决策者的情况下，医院必须寻求指定监护人作为法律认可的替代决策者。
本研究的目的是检查被转介进行监护的患者在医学上被认定可以出院后额外的住院时间（LOS）和医疗费用的规模。
设计、设置、患者：这是一项回顾性队列研究，研究对象为2014年10月1日至2015年9月30日期间在一家三级医疗中心医院需要监护的所有61名成年住院患者，并与同一出院科室的最多3名对照患者进行匹配，对照患者的住院时间至少与被转介患者的出院时间一样长。
使用广义估计方程测量以下参数：总住院时间、医学上被认定可以出院后的住院时间（额外住院时间）、医学并发症以及被转介患者的总费用，并将住院时间和费用与匹配的对照患者进行比较。
需要监护的患者的平均住院时间为31±2天，总费用平均为179,243±22,950美元。我们记录了10名（16%；95%置信区间[CI]，8%-28%）不同患者发生的12例医院获得性并发症。在考虑潜在混杂因素后，获得监护的过程与总住院时间延长37%（95%CI[12%-67%]；P = 0.002）、额外住院时间延长58%（95%CI[2%-145%]；P = 0.04）以及总费用增加23%（95%CI[4%-46%]；P = 0.02）相关。
在这项单中心队列研究中,即使与匹配的对照患者相比，监护过程也与住院时间延长和医院总费用增加相关。此外，六分之一的患者在医学上被认定可以出院后发生了与医院相关的并发症。
