在 COVID-19 期间，英国国民保健制度和独立部门的紧急合同和选择性护理服务的提供：描述性分析。

Emergency contracting and the delivery of elective care services across the English National Health Service and independent sector during COVID-19: a descriptive analysis.

机构信息

Department of Health Policy, The London School of Economics and Political Science, London, UK

Center for Global Development, Washington, District of Columbia, USA.

出版信息

BMJ Open. 2022 Jul 18;12(7):e055875. doi: 10.1136/bmjopen-2021-055875.

DOI:10.1136/bmjopen-2021-055875

PMID:35851029

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9296998/

Abstract

BACKGROUND

Following a virtual standstill in the delivery of elective procedures in England, a national block contract between the NHS and the independent sector aimed to help restart surgical care. This study aims to describe subsequent changes in trends in elective care service delivery following implementation of the initial iteration of this contract.

METHODS

Population-based retrospective cohort study, assessing the delivery of all publicly funded and privately funded elective care delivered in England between 1 April 2020 and 31 July 2020 compared with the same period in 2019. Discharge data from the Hospital Episode Statistics and private healthcare data from the Private Health Information Network was stratified by specialty, procedure, length of stay and patient complexity in terms of age and Charlson Comorbidity Index.

RESULTS

COVID-19 significantly reduced publicly funded elective care activity, though changes were more pronounced in the independent sector (-65.1%) compared with the NHS (-52.7%), whereas reductions in privately funded elective care activity were similar in both independent sector hospitals (-74.2%) and NHS hospitals (-72.9%). Patient complexity increased in the independent sector compared with the previous year, with mixed findings in NHS hospitals. Most specialties, irrespective of sector or funding mechanisms, experienced a reduction in hospital admissions. However, some specialities, including medical oncology, clinical oncology, clinical haematology and cardiology, experienced an increase in publicly-funded elective care activity in the independent sector.

CONCLUSION

Elective care delivered by the independent sector remained significantly below historic levels, although this overlooks significant variation between regions and specialities. There may be opportunities to learn from regions which achieved more significant increases in publicly funded elective care in independent sector providers as a strategy to address the growing backlog of elective care.

摘要

背景

在英格兰，择期手术的实施几乎陷入停滞之后，国民保健制度（NHS）与独立部门之间签订了一项全国性的统包合同，旨在帮助重启外科护理服务。本研究旨在描述该合同最初版本实施后，择期护理服务提供方面后续的变化趋势。

方法

这是一项基于人群的回顾性队列研究，评估了 2020 年 4 月 1 日至 7 月 31 日期间在英格兰提供的所有公共资助和私人资助的择期护理服务，与 2019 年同期相比。根据年龄和 Charlson 合并症指数，从医院入院统计数据中按专科、手术类型、住院时间和患者复杂性对出院数据进行分层，从私人医疗保健信息网络中按专科、手术类型、住院时间和患者复杂性对出院数据进行分层。

结果

COVID-19 显著减少了公共资助的择期护理活动，而独立部门的变化更为明显（-65.1%），而独立部门和国民保健制度医院的私人资助的择期护理活动减少情况相似（-74.2%和-72.9%）。与前一年相比，独立部门的患者复杂性增加，国民保健制度医院则存在混合结果。大多数专科，无论部门或资金机制如何，住院人数都有所减少。然而，一些专科，包括医学肿瘤学、临床肿瘤学、临床血液学和心脏病学，在独立部门的公共资助的择期护理活动中有所增加。