Harrison M L, Graff L A, Roos N P, Brownell M D
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg.
CMAJ. 1995 Sep 15;153(6):745-51.
To determine whether decreasing lengths of stay over time for selected diagnostic categories were associated with increased hospital readmission rates and mean number of physician visits after discharge.
Retrospective descriptive study.
The seven large (125 beds or more) acute care hospitals in Winnipeg.
Manitoba residents admitted to any one of the seven hospitals because acute myocardial infarction (AMI), bronchitis or asthma, transurethral prostatectomy (TURP) and uterine or adnexal procedures for nonmalignant disease during the fiscal years 1989-90 to 1992-93. Patients from out of province, those who died in hospital, those with excessively long stays (more than 60 days) and those who were transferred to or from another institution were excluded.
Length of hospital stay, and rate of readmission within 30 days after discharge for all four categories and mean number of physician visits within 30 days after discharge for two categories (AMI and bronchitis or asthma.
The length of stay decreased significantly over the 4 years for all of the four categories, the smallest change being observed for patients with AMI (11.1%) and the largest for those with bronchitis or asthma (22.0%). The readmission rates for AMI, bronchitis or asthma, and TURP showed no consistent change over the 4 years. The readmission rate for uterine or adnexal procedures increased significantly between the first and second year (chi 2 = 4.28, p = 0.04) but then remained constant over the next 3 years. The mean number of physician visits increased slightly for AMI in the first year (1.92 to 2.01) and then remained virtually the same. It decreased slightly for bronchitis or asthma over the 4 years. There was no significant correlation between length of stay and readmission rates for individual hospitals in 1992-93 in any of the four categories. Also, no correlation was observed between length of stay and mean number of physician visits for individual hospitals in 1992-93 in the categories AMI and bronchitis or asthma.
Improving hospital efficiency by shortening length of stay does not appear to result in increased rates of readmission or numbers of physician visits within 30 days after discharge from hospital. Research is needed to identify optimal lengths of stay and expected readmission rates.
确定特定诊断类别的住院时间随时间的缩短是否与再入院率增加以及出院后医生就诊的平均次数有关。
回顾性描述性研究。
温尼伯的七家大型（125张床位或更多）急症护理医院。
1989 - 90财年至1992 - 93财年因急性心肌梗死（AMI）、支气管炎或哮喘、经尿道前列腺切除术（TURP）以及非恶性疾病的子宫或附件手术而入住这七家医院中任何一家的曼尼托巴省居民。排除省外患者、在医院死亡的患者、住院时间过长（超过60天）的患者以及转至或转出其他机构的患者。
所有四个类别的住院时间、出院后30天内的再入院率，以及两个类别（AMI和支气管炎或哮喘）出院后30天内医生就诊的平均次数。
在这4年中，所有四个类别的住院时间均显著缩短，AMI患者的变化最小（11.1%），支气管炎或哮喘患者的变化最大（22.0%）。AMI、支气管炎或哮喘以及TURP的再入院率在这4年中没有一致的变化。子宫或附件手术的再入院率在第一年和第二年之间显著增加（χ² = 4.28，p = 0.04），但在接下来的3年中保持不变。AMI患者在第一年的医生就诊平均次数略有增加（从1.92次增至2.01次），然后基本保持不变。支气管炎或哮喘患者在这4年中的就诊次数略有减少。在1992 - 93年，任何一个类别中，各医院的住院时间与再入院率之间均无显著相关性。此外，在1992 - 93年，AMI和支气管炎或哮喘类别中，各医院的住院时间与医生就诊平均次数之间也未观察到相关性。
通过缩短住院时间来提高医院效率似乎并不会导致出院后30天内再入院率或医生就诊次数增加。需要进行研究以确定最佳住院时间和预期再入院率。
