Lanska D J
Department of Neurology, University of Kentucky Medical Center, Lexington 40536-0084.
J Neurol Sci. 1994 Dec 20;127(2):214-20. doi: 10.1016/0022-510x(94)90075-2.
To assess the temporal and spatial variation in length of hospital stay for cerebrovascular disease in the United States over three decades.
Age-, region-, and stroke type-specific length-of-hospital-stay data for nearly 4 million patients admitted with cerebrovascular disease were obtained for the Professional Activity Study of the Commission on Professional and Hospital Activities for the period 1963-1991.
Weighted averages and standard errors of length of stay were calculated for aggregate diagnosis groups within the category of cerebrovascular disease. Averages were age-adjusted by the direct method.
Average length of hospital stay declined from a peak of 18 days in 1967 to 8 days in 1991. The decline accelerated sharply from 1982 to 1986 coincident with implementation of the Medicare prospective payment system. Similar declines were observed within each age group, each cerebrovascular disease diagnosis group, and each census region. There were marked and persistent differences in average length of stay between regions, with longer stays in the Northeast and shorter stays in the West. The large interregional variation was not explained by differences in age or cerebrovascular disease diagnoses.
Implementation of the Medicare prospective payment system produced a marked decline in length of hospital stay for cerebrovascular disease, which was superimposed on a preexisting, but slower, decline. Much of the marked persistent interregional variation probably results from persistent widespread variation in patient management.
评估美国三十年来脑血管疾病住院时长的时空变化。
获取了专业医院活动委员会专业活动研究中1963 - 1991年期间近400万因脑血管疾病入院患者的年龄、地区和卒中类型特异性住院时长数据。
计算脑血管疾病类别内各总体诊断组的住院时长加权平均值和标准误差。平均值采用直接法进行年龄调整。
住院平均时长从1967年的峰值18天降至1991年的8天。1982年至1986年期间下降加速，这与医疗保险预付费系统的实施相一致。在每个年龄组、每个脑血管疾病诊断组和每个普查地区都观察到了类似的下降。各地区之间住院平均时长存在显著且持续的差异，东北部住院时间较长，西部较短。年龄或脑血管疾病诊断的差异无法解释这种较大的地区间差异。
医疗保险预付费系统的实施使脑血管疾病住院时长显著下降，这种下降叠加在先前已存在但较为缓慢的下降趋势之上。显著且持续的地区间差异很大程度上可能源于患者管理方面持续广泛存在的差异。
