Anderson G M
Institute for Clinical Evaluative Sciences in Ontario & Canadian Institute for Health Information, North York.
Med Care. 1997 Oct;35(10 Suppl):OS93-101. doi: 10.1097/00005650-199710001-00012.
The author highlights changes in hospital utilization that have occurred in association with restructuring of Ontario hospitals. The basic features of the epidemiology of hospital utilization described link the analysis of the organizational and structural components of hospitals with a more comprehensive evaluation of the impacts of their restructuring and have implications for international comparative studies.
Data from the Canadian Institute for Health Information and the Canadian census were analyzed to provide a population-based description of hospital utilization and care. These hospital data provided information on changes in the patterns of care that occurred during restructuring, based on hospital separations for the fiscal years 1991-1992 through 1995-1996.
Analysis of hospital utilization patterns revealed a 30% decrease in the days of care provided per 1,000 population during the period, the result of declines in both the age-adjusted inpatient separation rates and average length of hospital stay. The shift of surgical treatment to outpatient settings contributed to the reduction in inpatient days of care. The decline in utilization was experienced unevenly across age groups, with the elderly experiencing less of the decline than did younger age groups. Individuals living in the poorest areas used more inpatient care than did those living in the richest areas, although the gap in utilization narrowed over the period.
International comparisons of the epidemiology of hospital utilization and the impact of hospital restructuring will require the use of multiple data sources and the development of shared evaluative frameworks. Health data systems in Canada support the assessment of the broader impacts of hospital restructuring and offer a framework for developing research projects that can provide useful information on these important changes in health-care policy.
作者强调了安大略省医院重组所带来的医院利用情况的变化。所描述的医院利用流行病学的基本特征将医院组织和结构组成部分的分析与对其重组影响的更全面评估联系起来，并对国际比较研究具有启示意义。
分析了加拿大卫生信息研究所和加拿大人口普查的数据，以提供基于人群的医院利用和护理情况描述。这些医院数据提供了有关重组期间护理模式变化的信息，这些信息基于1991 - 1992财年至1995 - 1996财年的医院分离情况。
对医院利用模式的分析显示，在此期间每千人口提供的护理天数减少了30%，这是年龄调整后的住院分离率和平均住院时间下降的结果。手术治疗向门诊环境的转移导致了住院护理天数的减少。各年龄组的利用率下降情况不均衡，老年人的下降幅度小于年轻年龄组。生活在最贫困地区的人比生活在最富裕地区的人使用更多的住院护理，尽管在此期间利用率差距有所缩小。
对医院利用流行病学和医院重组影响进行国际比较需要使用多个数据源并制定共享的评估框架。加拿大的卫生数据系统支持对医院重组更广泛影响的评估，并提供了一个框架，用于开展能够提供有关这些重要卫生保健政策变化有用信息的研究项目。
