Martin Joanne, Raja Edwin Amalraj, Turner Steve
Child Health, University of Aberdeen, Aberdeen, AB25 2ZG, Scotland.
Medical Statistics Team, University of Aberdeen, Aberdeen, Scotland.
BMC Health Serv Res. 2021 Jan 21;21(1):75. doi: 10.1186/s12913-021-06070-7.
Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The "natural experiment" of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services?
There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one "reconfigured" hospital were halted (permanently or temporarily) and directed to a second "adjacent" hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the "reconfigured" and "adjacent" hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of "reconfigured" and "adjacent" hospitals, with adjustment for seasonality and an overall rising trend in admissions.
Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In "reconfigured" hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in "adjacent" hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named "adjacent" hospital.
There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the "adjacent" hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.
医院住院服务的重新配置包括完全或部分关闭所有急诊住院设施。住院服务重新配置这一“自然实验”可能有助于深入了解医院急诊入院的驱动因素。本研究探讨了住院服务重新配置后儿童急诊入院率是否发生变化这一问题。
2004年至2018年间，苏格兰医院进行了五次服务重新配置，其中一家“重新配置”医院的急诊入院（永久或临时）停止，并引导至另一家“相邻”医院。获取了重新配置前五年及之后长达五年时间里，每月“重新配置”医院和“相邻”医院的急诊入院人数（按区域人口中每1000名儿童标准化）。中断时间序列分析考虑了重新配置与由“重新配置”医院和“相邻”医院组成的配对医院入院之间的关联，并对季节性和入院人数的总体上升趋势进行了调整。
在五次重新配置事件中，两次是立即关闭，两次仅涉及关闭过夜入院服务，一次是过夜关闭一段时间后再关闭。与重新配置前一年相比，“重新配置”医院在重新配置后的一年中平均每月入院人数下降了117例[95%置信区间78, 156]，而“相邻”医院的入院人数每月增加了82例[32, 131]。在重新配置的配对医院和相邻医院中，重新配置后的几个月里，一对医院的入院总数放缓，另一对医院加速入院，三对医院入院率不变。一家医院重新配置后到第三家比指定“相邻”医院更近的医院的入院人数有所增加。
住院设施重新配置后急诊入院人数的结果各不相同。包括当地重新配置后社区的资源、到“相邻”医院的距离和当地贫困程度等因素可能是重新配置后入院途径的重要驱动因素。考虑重新配置政策的制定者可能需要考虑一些可能是重新配置后入院重要决定因素因素因素。 （注：原文最后一句重复“因素”一词有误，译文按正确理解翻译）
