Nimptsch Ulrike
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
Isr J Health Policy Res. 2020 Apr 30;9(1):19. doi: 10.1186/s13584-020-00380-7.
Uncertainty about intended and possible unintended side effects makes it important to evaluate changes following health policy decisions. A recent IJHPR article by Greenberg et al. evaluated changes in emergency department care following a directive of the Israeli Ministry of Health to limit occupancy in internal medicine wards. Over a six-year observation period, they found that one-month mortality and one-week readmissions after ED visits remained unchanged, while increases in average ED visit length, as well as increased delay time from ED admission to ward were observed. These findings help to assess the impact of the occupancy limit directive and may support future health policy decisions.However, the study by Greenberg et al. was limited by the unavailability of diagnostic data, and this illustrates a significant issue that transcends this particular study. In many countries, policy-relevant administrative data are not sufficiently available on a timely basis. Data availability is the prerequisite for monitoring developments in patterns of care following health policy changes. Besides conducting retrospective studies, timely availability of data makes it possible to establish monitoring systems which may help decision makers assess the impact of policy changes, identify undesired developments early, and recognize changes in need or demand of health services within the population.
由于预期和可能的非预期副作用存在不确定性，因此评估卫生政策决策后的变化非常重要。格林伯格等人最近在《国际卫生政策与管理杂志》上发表的一篇文章评估了以色列卫生部发布的一项限制内科病房占用率的指令后急诊科护理的变化。在六年的观察期内，他们发现急诊就诊后的一个月死亡率和一周再入院率保持不变，而平均急诊就诊时长增加，且从急诊科入院到病房的延迟时间也有所增加。这些发现有助于评估占用率限制指令的影响，并可能为未来的卫生政策决策提供支持。然而，格林伯格等人的研究受到诊断数据不可用的限制，这说明了一个超越这项具体研究的重大问题。在许多国家，与政策相关的行政数据未能及时充分获取。数据可用性是监测卫生政策变化后护理模式发展的前提条件。除了开展回顾性研究外，及时获取数据还能够建立监测系统，这可能有助于决策者评估政策变化的影响、尽早发现不良发展情况，并认识到人群中卫生服务需求或需要方面的变化。
