Goodrich T J, Gorry G A
Am J Public Health. 1980 Mar;70(3):251-5. doi: 10.2105/ajph.70.3.251.
In a study of 300 chronically ill patients who were referred from an outpatient department to community health centers in a public hospital district, we found that the number of visits made, the amount of medicine prescribed, and the number of tests ordered all increased markedly for those patients in the 6 months immediately following their referral. As a result, there was substantial increase in the charges incurred for their care. The care itself changed as well. The physicians at the centers on the whole differed from those at the hospital in the emphasis they placed upon various types of visits, medicines, and tests. There were also large differences among the community health centers along these dimensions. The findings indicate the difficulty of providing comparable care at a comparable cost within a large health care system.
在一项针对300名慢性病患者的研究中，这些患者从一家公立医院区的门诊部被转诊至社区卫生中心，我们发现，在转诊后的6个月内，这些患者的就诊次数、所开药物数量以及所安排的检查数量均显著增加。结果，他们的护理费用大幅上涨。护理本身也发生了变化。总体而言，社区卫生中心的医生在各类就诊、药物和检查的侧重点上与医院的医生不同。在这些方面，各社区卫生中心之间也存在很大差异。这些发现表明，在一个大型医疗系统内以可比成本提供可比护理存在困难。
