Goldman R S, Hartz A J, Lanska D J, Guse C E
Department of Neurology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA.
Stroke. 1996 Apr;27(4):639-44. doi: 10.1161/01.str.27.4.639.
Effective methods to monitor length of stay can help reduce unnecessary hospital stay without adversely affecting the quality of care. In this study a clinical algorithm for assessing unjustified hospital stay in stroke patients was computerized and tested.
An algorithm was developed by the authors to estimate the number of medically justified and unjustified hospital days for patients admitted with a primary diagnosis of ischemic stroke. Data for the algorithm were obtained from 177 stroke patients from an acute-care teaching hospital. The performance of the algorithm was evaluated on a subset of 46 patients by comparing the number of medically unjustified hospital days determined by the algorithm with the consensus determination of two neurologists.
The algorithm classified 68% of the 177 patients as having some unjustified hospital days and 41% of all hospital days as unjustified. With the neurologists as the gold standard, the sensitivity of the algorithm was .89 and the specificity was .91. The correlation between the number of unjustified days determined by the algorithm and the neurologists was .76.
There is considerable unjustified length of stay for stroke patients. Physicians can develop simple clinical algorithms for detecting unjustified hospital stay in stroke patients that provide a reasonable approximation of complex clinical judgment.
有效的住院时间监测方法有助于减少不必要的住院时间，且不会对医疗质量产生不利影响。在本研究中，对一种评估中风患者不合理住院时间的临床算法进行了计算机化处理并进行了测试。
作者开发了一种算法，用于估计以缺血性中风为主要诊断入院患者的合理和不合理住院天数。该算法的数据来自一家急症教学医院的177名中风患者。通过将算法确定的不合理住院天数与两位神经科医生的共识判断进行比较，在46名患者的子集中评估了该算法的性能。
该算法将177名患者中的68%归类为有一些不合理住院天数，将所有住院天数的41%归类为不合理。以神经科医生的判断为金标准，该算法的敏感性为0.89，特异性为0.91。算法确定的不合理天数与神经科医生确定的天数之间的相关性为0.76。
中风患者存在相当多的不合理住院时间。医生可以开发简单的临床算法来检测中风患者的不合理住院时间，这些算法能合理近似复杂的临床判断。
