NHS Greater Glasgow and Clyde, Glasgow, UK
NHS Greater Glasgow and Clyde, Glasgow, UK.
J Epidemiol Community Health. 2019 Jul;73(7):674-679. doi: 10.1136/jech-2018-211628. Epub 2019 Apr 20.
Intermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed.
Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality.
Prior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of -15.20 (95% CI -17.52 to -12.88) and a trend change of -0.29 (95% CI -0.55 to -0.02). This is equivalent to a predicted reduction due to IC of -16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%.
IC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.
中级护理（IC）作为医院和家庭之间的桥梁服务，为那些被认为适合出院但在医院延迟的患者提供服务。本研究旨在测量 IC 和 72 小时出院目标对延迟天数的影响。
使用分段线性回归，比较格拉斯哥市 75 岁以上人口每 1000 人延迟天数的比率，在 IC 开始前和 6 个月的逐步实施期间。因弗克莱德和西邓巴顿（IWD）为对照组。模型中包含自回归和移动平均项，以及傅里叶项以调整季节性。
在 IC 开始之前，格拉斯哥市和苏格兰其他地区的延迟天数率都有所增加。在逐步实施期间，格拉斯哥市的延迟天数率大幅下降，降幅大于苏格兰其他地区，但与 IWD 观察到的降幅相当，此后又有所增加。调整 IWD 的变化后，格拉斯哥市 IC 和出院目标的影响是水平变化-15.20（95%CI-17.52 至-12.88）和趋势变化-0.29（95%CI-0.55 至-0.02）。这相当于 2016 年 6 月每 1000 人每月因 IC 而延迟的天数减少 16.04 天，相对减少 35%。
IC 和 72 小时出院目标与延迟天数的减少有关。尽管随着时间的推移，延迟天数继续增加，但增加的速度比没有实施 IC 要慢。
