Samuels B N, Novack A H, Martin D P, Connell F A
District Four Health Services, LaGrange, Georgia, USA.
Pediatrics. 1998 Apr;101(4):E13. doi: 10.1542/peds.101.4.e13.
To determine whether length of stay (LOS) for asthma admissions at a local university-affiliated children's hospital (UACH) is similar to that of community hospitals within the same county.
A retrospective analysis was performed using computerized hospital abstract records from 1989 through 1994. The study population was children 1 to 18 years old whose first or only hospitalization for a primary diagnosis of asthma occurred during the study period at either the UACH or one of the 17 community hospitals in King County, WA, that admit pediatric patients (n = 2491). Transfers and patients with chronic obstructive asthma or secondary diagnoses such as cystic fibrosis were not included in the study. Asthma patients were compared by sociodemographic and health risk characteristics such as age, sex, insurance status, and a comorbidity severity score. Differences between the two hospital populations were tested by chi2 and t tests. The effect of hospitalization at the UACH or the community hospitals on LOS was determined using analysis of covariance after adjusting for the sociodemographic and health risk covariates.
Sixty-two percent (62%) of the asthma patients in the study population were discharged from the UACH. Compared with patients discharged from the community hospitals, the UACH patients were significantly younger, more often male, used public insurance, and resided in areas with lower median household incomes. The severity of comorbidities was not different between the two hospital groups. Overall, adjusted mean LOS was not significantly longer at the UACH (2.1 days) than at the community hospitals (2.0 days); however, adjusted mean LOS for specific subgroups, most notably poor children and those with public insurance, was significantly longer at the UACH.
LOS for first or only asthma hospitalizations during 1989 through 1994 at the UACH was similar to local community hospitals within the same county. Specific subgroups of children were hospitalized for a longer period at the UACH, but children with private insurance and from areas with higher median household incomes had similar LOS, and presumably costs, at the UACH and the community hospitals.
确定当地一所大学附属医院（UACH）哮喘住院患者的住院时间（LOS）是否与同一县内社区医院的住院时间相似。
利用1989年至1994年的计算机化医院摘要记录进行回顾性分析。研究人群为1至18岁的儿童，他们在研究期间因哮喘初次诊断或唯一一次住院治疗在UACH或华盛顿州金县17家收治儿科患者的社区医院之一（n = 2491）。研究不包括转院患者以及患有慢性阻塞性哮喘或继发诊断如囊性纤维化的患者。根据年龄、性别、保险状况和合并症严重程度评分等社会人口统计学和健康风险特征对哮喘患者进行比较。通过卡方检验和t检验检测两所医院人群之间的差异。在调整社会人口统计学和健康风险协变量后，使用协方差分析确定在UACH或社区医院住院对住院时间的影响。
研究人群中62%的哮喘患者从UACH出院。与从社区医院出院的患者相比，UACH患者明显更年轻，男性比例更高，使用公共保险，且居住在家庭收入中位数较低的地区。两所医院组之间合并症的严重程度没有差异。总体而言，UACH调整后的平均住院时间（2.1天）并不比社区医院（2.0天）显著更长；然而，特定亚组的调整后平均住院时间，最显著的是贫困儿童和有公共保险的儿童，在UACH明显更长。
1989年至1994年期间，UACH首次或唯一一次哮喘住院的住院时间与同一县内的当地社区医院相似。特定亚组儿童在UACH的住院时间更长，但有私人保险且来自家庭收入中位数较高地区的儿童在UACH和社区医院的住院时间相似，推测费用也相似。
