Shea S, Sideli R V, DuMouchel W, Pulver G, Arons R R, Clayton P D
Department of Medicine, Columbia University, New York, NY.
J Am Med Inform Assoc. 1995 Jan-Feb;2(1):58-64. doi: 10.1136/jamia.1995.95202549.
With the advent of hospital payment by diagnosis-related group (DRG), length of stay (LOS) has become a major issue in hospital efforts to control costs. Because the Columbia-Presbyterian Medical Center (CPMC) has had above-average LOSs for many DRGs, the authors tested the hypothesis that a computer-generated informational message directed to physicians would shorten LOS.
Randomized clinical trial with the patient as the unit of randomization.
From June 1991 to April 1993, at CPMC in New York, 7,109 patient admissions were randomly assigned to an intervention (informational message) group and 6,990 to a control (no message) group.
A message giving the average LOS for the patient's admission or provisional DRG, as assigned by hospital utilization review, and the current LOS, in days, was included in the main menu for review of test results in the hospital's clinical information system, available at all nursing stations in the hospital.
Hospital LOS.
The median LOS for study patients was 7 days. After adjustment for covariates including age, sex, payor, patient care unit, and time trends, the mean LOS in the intervention group was 3.2% shorter than that in the control group (p = 0.022).
Computer-generated patient-specific LOS information directed to physicians was associated with a reduction in hospital LOS.
随着按诊断相关分组（DRG）支付医院费用方式的出现，住院时间（LOS）已成为医院控制成本工作中的一个主要问题。由于哥伦比亚长老会医学中心（CPMC）在许多DRG分组中的住院时间高于平均水平，作者检验了这样一个假设，即向医生发送计算机生成的信息性消息会缩短住院时间。
以患者为随机分组单位的随机临床试验。
1991年6月至1993年4月，在纽约的CPMC，7109例患者入院病例被随机分配到干预（信息性消息）组，6990例被分配到对照（无消息）组。
一条包含医院利用审查分配的患者入院或临时DRG的平均住院时间以及当前住院天数的消息，被纳入医院临床信息系统中检验结果查看主菜单，医院所有护理站均可获取。
医院住院时间。
研究患者的中位住院时间为7天。在对年龄、性别、付款人、患者护理单元和时间趋势等协变量进行调整后，干预组的平均住院时间比对照组短3.2%（p = 0.022）。
向医生发送计算机生成的针对特定患者的住院时间信息与医院住院时间缩短相关。
