Inglis A L, Coast J, Gray S F, Peters T J, Frankel S J
University of Bristol, Department of Social Medicine, UK.
Med Care. 1995 Sep;33(9):952-7.
Assessing the appropriateness of hospital utilization in the United Kingdom may yield practical solutions to problems faced by both purchasers and providers of health care in the National Health Service. It is, however, essential that such assessment is based on a method that is both valid and reliable--in particular, valid in the context in which it is applied. Whereas American methods for the assessment of appropriateness have been shown to be valid in the United States, it is pertinent to question whether the application of such methods to the National Health Service also is valid given the different circumstances, both cultural and financial, under which health care is provided. A study of the appropriateness of admission and hospital stay for a sample of admissions to a large acute hospital in the United Kingdom was carried out, and the assessment of appropriateness was made using the Intensity-Severity-Discharge Review System with Adult criteria (ISD-A). The validity and reliability of using the ISD-A for assessing hospital utilization in the United Kingdom was evaluated. The ISD-A was found to have high reliability and to be valid for assessing appropriateness in the United Kingdom when a full range of alternative forms of care are presumed to be available. It was not found to be valid currently, therefore, for routine assessment of hospital utilization within the National Health Service, when alternatives often are not available.
评估英国医院资源利用的合理性，可能会为国民医疗服务体系中医疗服务的购买者和提供者所面临的问题找到切实可行的解决方案。然而，至关重要的是，这种评估必须基于一种既有效又可靠的方法——特别是在其应用背景下有效。虽然美国评估合理性的方法已在美国被证明是有效的，但鉴于英国提供医疗服务时文化和财政等不同的情况，质疑将这些方法应用于国民医疗服务体系是否也有效是恰当的。对英国一家大型急症医院的部分入院病例的入院和住院时间的合理性进行了研究，并使用成人标准的强度-严重程度-出院审查系统（ISD-A）对合理性进行评估。评估了使用ISD-A评估英国医院资源利用的有效性和可靠性。研究发现，当假定有各种替代护理形式时，ISD-A具有很高的可靠性，并且在英国评估合理性方面是有效的。因此，当替代护理形式通常不存在时，目前发现它对于国民医疗服务体系内医院资源利用的常规评估是无效的。
