Akshija I, Dibra A
G Chir. 2018 Sep-Oct;34(5):265-271.
Quantification of elective and emergency hospital admissions as a resultant of patients' diagnostic and therapeutic pathways (referral system) and patients' preferences to choose the health-care provider.
Retrospective analysis of routine hospital discharge data. Findings were analyzed with descriptive statistical methods.
University Hospital Center, "Mother Teresa", Albania, a secondary and tertiary health care provider to the capital Tirana and tertiary health care provider for the rest of Albania.
692,284 hospital admissions during eleven years period, 2006-2016.
Hospital admission trends measured as Average Annual Percentage Change and standardized admissions by district per 100,000 inhabitants.
Number of hospital admissions increased from 55,528 in the baseline year to 78,130 in the last year of our study. During eleven years ALOS changed from 7.60 to 5.80 days and BOR increased from 83.2% to 91.6%. AAPC total, Average Annual Percentage Change was 3.2% at the ending year, 2006 to 2016. Cramér's V between variables 'year of admission' and 'prefecture' was 0.024, p < 0.001 and between 'year of admission' and 'Tirana University Hospital Center administrative units' was 0.055, p < 0.001. Both relationships are weak but significant. Maps show the exaggerated flow from other districts towards Tirana.
Patient satisfaction, as a health care quality metric, is a driving force towards the choice of health provider. The satisfied patient chooses again or tells the next patient the preferred provider. The perceived professional difference among health care providers has built a competitive environment. The referral system puts strict rules over patient pathway which in his turn finds ways to bypass it if preferences are not taken in consideration. Commitment to such rules is accepted till forces considered as expression of free choice overcome them, jeopardizing the performance of the whole system. Patient's preferences deserve to be evaluated and incorporated in the patient pathway design.
对因患者诊断和治疗途径（转诊系统）以及患者选择医疗服务提供者的偏好而导致的择期和急诊住院情况进行量化。
对常规医院出院数据进行回顾性分析。采用描述性统计方法对研究结果进行分析。
阿尔巴尼亚“特蕾莎修女”大学医院中心，是首都地拉那的二级和三级医疗服务提供者，也是阿尔巴尼亚其他地区的三级医疗服务提供者。
2006年至2016年这十一年期间的692284例住院病例。
以年均百分比变化衡量的住院趋势以及按地区每10万居民计算的标准化住院人数。
在我们研究的最后一年，住院人数从基准年的55528例增加到78130例。在这十一年间，平均住院日从7.60天变为5.80天，床位占用率从83.2%增至91.6%。2006年至2016年最后一年的年均总百分比变化（AAPC）为3.2%。变量“入院年份”与“州”之间的克莱默V系数为0.024，p<0.001；“入院年份”与“地拉那大学医院中心行政单位”之间的克莱默V系数为0.055，p<0.001。这两种关系都较弱但具有显著性。地图显示了从其他地区向地拉那夸张的流量。
患者满意度作为医疗质量指标，是患者选择医疗服务提供者的驱动力。满意的患者会再次选择或告知下一位患者其偏好的医疗服务提供者。医疗服务提供者之间感知到的专业差异营造了竞争环境。转诊系统对患者就医途径设定了严格规则，但如果不考虑患者偏好，患者会设法绕过这些规则。在被视为自由选择表达的力量克服这些规则之前，对这些规则的遵守是被接受的，这会危及整个系统的运行。患者的偏好值得评估并纳入患者就医途径设计中。
