Ancona-Berk V A, Chalmers T C
Am J Public Health. 1986 Sep;76(9):1102-4. doi: 10.2105/ajph.76.9.1102.
Savings resulting from the substitution of ambulatory for inpatient care have been widely reported. This study examined the hypothesis that these savings may result from a reduction of services provided to the ambulatory patient and/or from an incomplete evaluation of these services, when the market value of relatives' support services is not included. Cataract extraction was chosen as an example. Sixty-two medical records of patients admitted to Mount Sinai for cataract extraction in the first six months of 1980 were reviewed, and the cost of their stay was estimated. This cost was then compared to five simulations of home care costs. The simulations differed among themselves primarily as to the experience and training of the person providing nursing services--from an RN to an untrained relative. The quantity and type of service provided to inpatients were assumed to be provided to ambulatory patients in all five simulations. The results of the comparison of hospital costs to home costs were that, in the case of post-cataract extraction, home care is less costly than hospital care either if fewer services are provided to home patients or if the cost of some services assumed by relatives is not calculated.
用门诊护理替代住院护理所产生的节省费用情况已被广泛报道。本研究检验了这样一种假设：当未计入亲属支持服务的市场价值时，这些节省费用可能源于向门诊患者提供的服务减少和/或对这些服务的评估不完整。以白内障摘除为例。回顾了1980年头六个月在西奈山医院接受白内障摘除手术的62例患者的病历，并估算了他们的住院费用。然后将这笔费用与五种家庭护理费用模拟情况进行比较。这些模拟情况之间的主要差异在于提供护理服务人员的经验和培训程度——从注册护士到未经培训的亲属。在所有五种模拟情况中，假定向住院患者提供的服务数量和类型也提供给门诊患者。将住院费用与家庭护理费用进行比较的结果是，就白内障摘除术后而言，如果向家庭患者提供的服务较少，或者未计算亲属承担的某些服务的费用，那么家庭护理的成本低于住院护理。
