中国 COVID-19 疫情防控政策调整后,一种 ICU 床位优化配置方法对平均住院时间和住院费用的影响:基于中国西南地区一家三级医院信息管理系统数据的双重差分分析。
Impact of an ICU bed capacity optimisation method on the average length of stay and average cost of hospitalisation following implementation of China's open policy with respect to COVID-19: a difference-in-differences analysis based on information management system data from a tertiary hospital in southwest China.
机构信息
School of Business, Sichuan Unversity, Chengdu, China.
The Hong Kong Polytechnic University, Hong Kong, China.
出版信息
BMJ Open. 2024 Apr 19;14(4):e078069. doi: 10.1136/bmjopen-2023-078069.
OBJECTIVES
Following the implementation of China's open policy with respect to COVID-19 on 7 December 2022, the influx of patients with infectious diseases has surged rapidly, necessitating hospitals to adopt temporary requisition and modification of ward beds to optimise hospital bed capacity and alleviate the burden of overcrowded patients. This study aims to investigate the effect of an intensive care unit (ICU) bed capacity optimisation method on the average length of stay (ALS) and average cost of hospitalisation (ACH) after the open policy of COVID-19 in China.
DESIGN AND SETTING
A difference-in-differences (DID) approach is employed to analyse and compare the ALS and ACH of patients in four modified ICUs and eight non-modified ICUs within a tertiary hospital located in southwest China. The analysis spans 2 months before and after the open policy, specifically from 5 October 2022 to 6 December 2022, and 7 December 2022 to 6 February 2023.
PARTICIPANTS
We used the daily data extracted from the hospital's information management system for a total of 5944 patients admitted by the outpatient and emergency access during the 2-month periods before and after the release of the open policy in China.
RESULTS
The findings indicate that the ICU bed optimisation method implemented by the tertiary hospital led to a significant reduction in ALS (HR -0.6764, 95% CI -1.0328 to -0.3201, p=0.000) and ACH (HR -0.2336, 95% CI -0.4741 to -0.0068, p=0.057) among ICU patients after implementation of the open policy. These results were robust across various sensitivity analyses. However, the effect of the optimisation method exhibits heterogeneity among patients admitted through the outpatient and emergency channels.
CONCLUSIONS
This study corroborates a significant positive impact of ICU bed optimisation in mitigating the shortage of medical resources following an epidemic outbreak. The findings hold theoretical and practical implications for identifying effective emergency coordination strategies in managing hospital bed resources during sudden public health emergency events. These insights contribute to the advancement of resource management practices and the promotion of experiences in dealing with public health emergencies.
目的
2022 年 12 月 7 日中国实施新冠疫情开放政策后,传染病患者涌入迅速增加,医院需要临时征用和改造病房床位,以优化医院床位容量,缓解患者拥挤的负担。本研究旨在探讨中国新冠疫情开放政策后,重症监护病房(ICU)床位优化方法对 ICU 患者平均住院时间(ALS)和平均住院费用(ACH)的影响。
设计和设置
采用双重差分(DID)方法分析比较中国西南地区一家三级医院 4 个改建 ICU 和 8 个非改建 ICU 中患者的 ALS 和 ACH。分析跨越开放政策前后 2 个月,具体为 2022 年 10 月 5 日至 12 月 6 日和 2022 年 12 月 7 日至 2023 年 2 月 6 日。
参与者
我们使用从医院信息管理系统提取的每日数据,共纳入开放政策前后 2 个月期间通过门诊和急诊就诊的 5944 名患者。
结果
研究结果表明,三级医院实施的 ICU 床位优化方法显著降低了 ALS(HR-0.6764,95%CI-1.0328 至-0.3201,p=0.000)和 ACH(HR-0.2336,95%CI-0.4741 至-0.0068,p=0.057),在开放政策实施后 ICU 患者中。这些结果在各种敏感性分析中均具有稳健性。然而,优化方法的效果在通过门诊和急诊渠道入院的患者中存在异质性。
结论
本研究证实了 ICU 床位优化在缓解疫情爆发后医疗资源短缺方面具有显著的积极影响。这些发现为识别应对突发公共卫生事件时医院床位资源的有效应急协调策略提供了理论和实践意义。这些见解有助于推进资源管理实践和推广应对公共卫生突发事件的经验。