英国国民医疗服务体系（NHS）中取消的择期手术及28天违规情况：对2002年处罚政策、2008年经济衰退和新冠疫情（1994 - 2023年）的中断时间序列分析

Cancelled elective operations and 28-day breaches in the NHS in England: an interrupted time series analysis of the 2002 penalty policy, 2008 recession, and COVID-19 pandemic (1994-2023).

作者信息

Quinn Laura, Bird Paul, Hofer Timothy P, Lilford Richard

机构信息

Department of Applied Health Sciences, University of Birmingham, Birmingham, UK.

NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.

出版信息

Lancet Reg Health Eur. 2025 Jul 2;56:101368. doi: 10.1016/j.lanepe.2025.101368. eCollection 2025 Sep.

DOI:10.1016/j.lanepe.2025.101368

PMID:40688043

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12270809/

Abstract

BACKGROUND

In 2002, the English National Health Service (NHS) introduced financial penalties for hospitals failing to provide elective operations within 28 days of last-minute cancellations. This study investigates the impact of this policy, the 2008 global recession, and the COVID-19 pandemic on cancelled operations and breaches of the 28-day standard.

METHODS

We conducted a retrospective observational study using publicly available NHS England data from 1994 to 2023. Interrupted time series analysis assessed changes in cancelled operations and breaches of the 28-day standard across three key periods: pre- and post-2002 policy implementation, post-2008 recession, and post-COVID-19 pandemic. Subgroup analysis by hospital trust A&E department presence on breaches of the 28-day standard was performed.

FINDINGS

Elective admissions nearly doubled over 30 years, rising from just over 1 million per quarter in 1994 (1,054,818) to almost 2 million in 2023 (1,975,508), an 87% increase. Cancellation rates increased leading up to the 2002 policy change but fell rapidly below 1% afterwards and remained stable. The 2008 recession and COVID-19 pandemic did not impact cancellation rates, but did increase breaches of the 28-day standard. Breaches rose before the 2002 policy, dropped rapidly afterwards (-9.6%, 95% CI: -11.2, -9.0), but increased after the recession and notably post-pandemic (13.0%, 95% CI: 4.9%, 21.0%), remaining high and negating earlier gains. Hospitals with A&E departments experienced higher post-pandemic increases in breach rates (12.7%, 95% CI: 10.8, 14.7) compared to those without (0.3%, 95% CI: -3.7, 4.4).

INTERPRETATION

The 2002 policy effectively reduced breaches of the 28-day standard for many years but could not be maintained after the COVID-19 pandemic, when breach rates reached high levels, especially hospitals with A&E departments that could not protect elective beds. Effective targets require sufficient resource capacity and demand management, ignoring such constraints can lead to self-defeating, unjust policies.

FUNDING

National Institute for Health and Care Research Applied Research Collaboration West Midlands (NIHR200165).

摘要

背景

2002年，英国国家医疗服务体系（NHS）对未能在最后一刻取消手术的28天内提供择期手术的医院实施了经济处罚。本研究调查了该政策、2008年全球经济衰退以及新冠疫情对取消手术和违反28天标准的影响。

方法

我们使用了1994年至2023年英国国家医疗服务体系（NHS）英格兰地区公开可用的数据进行了一项回顾性观察研究。中断时间序列分析评估了三个关键时期取消手术和违反28天标准的变化情况：2002年政策实施前后、2008年经济衰退后以及新冠疫情后。对医院信托急诊科是否存在对违反28天标准的情况进行了亚组分析。

结果

30年间择期入院人数几乎翻了一番，从1994年每季度略超过100万（1,054,818）增至2023年近200万（1,975,508），增长了87%。在2002年政策变更前取消率上升，但之后迅速降至1%以下并保持稳定。2008年经济衰退和新冠疫情并未影响取消率，但确实增加了违反28天标准的情况。在2002年政策之前违规情况增加，之后迅速下降（-9.6%，95%置信区间：-11.2，-9.0），但在经济衰退后尤其是疫情后增加（13.0%，95%置信区间：4.9%，21.0%），居高不下并抵消了早期的成果。与没有急诊科的医院相比，有急诊科的医院在疫情后的违规率上升幅度更大（12.7%，95%置信区间：10.8，14.7）（0.3%，95%置信区间：-3.7，4.4）。