平均住院日影响因素探析

国内外的研究表明,平均住院日在不同的国家、同一国家的不同地区、同一地区的不同医院、同一医院的不同科室、不同时间段上有很大差异。本文通过国内外文献评阅,从患者因素、医院内部因素、社会因素和其他因素四个方面对影响平均住院日的因素进行了综述,为我国医院管理者和研究者研究如何缩短平均住院日、提高医院效率提供系统的理论框架。     

Impact of Nutritional Intervention on Length of Hospital Stay and Mortality among Hospitalized Patients with Malnutrition: A Clinical Randomized Controlled Trial

Objective: The objective of this study was to evaluate the impact of a nutritional intervention on hospital stay and mortality among hospitalized patients with malnutrition.

Methods: Hospitalized patients with a diagnosis of malnutrition were enrolled and randomly allocated to either an intervention or control group. Participants in the intervention group received an individualized nutrition plan according to energy and protein (1.0–1.5 g/kg) intake requirements as well as dietary advice based on face-to-face interviews with patients and their caregivers or family members. Individuals in the control group received standard nutritional management according to the Hospital Nutrition Department. Nutritional status and disease severity were assessed using nutritional risk screening. Length of hospital stay was defined by the number of days of hospitalization from hospital admission to medical discharge. Reference to another service or death were criteria for study withdrawal. To evaluate mortality, individuals were followed up for 6 months after hospital discharge. Hospital stay and mortality were the intention-to-treat analysis.

Results: A total of 55 patients with an average age of 57.1 ± 20.7 years were included into intervention (n = 28) and control (n = 27) groups, respectively. At basal condition, nutritional status, measured by nutritional risk screening score, was similar between the study groups (4.1 ± 0.8 vs 4.2 ± 1.2, p = 0.6). The average hospital stay was lower in the intervention group compared to the control group (6.4 ± 3.0 vs 8.4 ± 4.0 days, p = 0.03). Finally, the mortality rate at 6 months of follow-up was similar in both groups (hazard ratio [HR] = 0.85; 95% confidence interval [CI], 0.17–4.21).

Conclusions: Results of this study suggest that, in hospitalized patients with malnutrition, nutritional intervention and dietary advice decrease hospital stay but not mortality.     

浅析医院平均住院日的影响因素

影响平均住院日的因素很多,有医院内部因素,也有医院外部因素包括诸如国家医保政策、患者因素等医院不可控因素;该文主要就医院内部管理层面影响平均住院日的因素进行分析,这些因素可以通过医院自身采取措施得以调控,从而达到缩短平均住院日的目的。     

影响平均住院日的主要因素分析与对策

平均住院日是评价医院效率、医疗质量、管理水平的综合性指标之一。通过对医院近3年来平均住院日等相关核心医疗指标的分析,找出影响医院平均住院日的主要因素,深入研究并提出对策,以便采取科学合理的措施,在确保医疗质量和医疗安全的同时,有效缩短平均住院日,降低患者医疗费用,提高医院的社会效益和经济效益。     

国内医院缩短平均住院日的研究现状

综述了缩短平均住院日的重要意义、影响平均住院日的因素、平均住院日的标准和评估方法、缩短平均住院日的措施与对策。     

The association between smoking status and hospital length of stay: evidence from a hospital-based cohort

Objectives: Smoking is recognized as one of the main preventable causes of mortality and morbidity that imposes a high financial burden on healthcare systems and society. This study aimed to examine the association between smoking status and hospital length of stay (LOS) among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014.

Methods: A total of 1271 patients (415 LC patients, 427 COPD patients and 429 IHD patients) were included in the study. Data on age, sex, insurance status and LOS was extracted from the patients’ medical records and smoking status was obtained from the patients using telephone survey. The LOS among current smokers, former smokers, and nonsmokers was compared using a zero-truncated poisson regression. Analysis was done using STATA v.12.

Results: The mean LOS for current smokers, former smokers and nonsmokers was 9.4±8.4, 7.3 ±5.3 and 6.02±5.05 days, respectively. The unadjusted and adjusted probabilities of LOS for current smokers and former smokers were 56% and 21% and 48% and 15% higher, respectively, than when compared with the nonsmoker category.

Conclusion: The study demonstrated longer LOS for the current and former smokers, contributing to the drain on large hospital resources in Iran. The results of the study provide useful information for health-policy makers that contribute to the planning and designing of smoking cessation interventions in this area.     

Incidence of nutritional risk and causes of inadequate nutritional care in hospitals

BACKGROUND AND AIMS: Many patients in hospitals are undernourished and nutritional care is inadequate in most hospitals. The aim of this investigation was to gain insight into how this situation could be improved. METHODS: Seven hundred and fifty randomly selected patients were screened at admission in three hospitals and surveyed during their entire hospitalization. Each time a patient was not treated according to a clearly defined nutritional standard, the nurse responsible for the patient was interviewed about possible reasons according to preformed questionnaires. RESULTS: The investigators found that 22% of the patients were nutritionally at-risk, and that only 25% of these patients received an adequate amount of energy and protein. The departments had only screened for nutritional problems in 60% of the cases. Only 47% of the patients, who the departments judged to be at-risk patients, had a nutrition plan worked out, and only about 30% of the at-risk patients were monitored by the departments by recording of dietary intake and/or body weight. The main causes for inadequate nutritional care were lack of instructions to deal with these problems, and lack of basic knowledge with respect to dietary requirements and practical aspects of the hospital's food provision. Patient-related aspects and the system of food provision also contributed, but only to a small degree. CONCLUSIONS: These findings form the basis of the strategy to improve nutritional care in these hospitals.     

Determinants of the Length of Stay in Stroke Patients

ObjectivesThe study objective was to identify the factors that influence the length of stay (LOS) in hospital for stroke patients and to provide data for managing hospital costs by managing the LOS.MethodsThis study used data from the Discharge Injury Survey of the Korea Centers for Disease Control and Prevention, which included 17,364 cases from 2005 to 2008.ResultThe LOS for stroke, cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage was 18.6, 15.0, 28.9, and 25.3 days, respectively. Patients who underwent surgery had longer LOS. When patients were divided based on whether they had surgery, there was a 2.4-time difference in the LOS for patients with subarachnoid hemorrhage, 2.0-time difference for patients with cerebral infarction, and 1.4-time difference for patients with intracerebral hemorrhage. The emergency route of admission and other diagnosis increased LOS, whereas hypertension and diabetic mellitus reduced LOS.ConclusionIn the present rapidly changing hospital environments, hospitals approach an efficient policy for LOS, to maintain their revenues and quality of assessment. If LOS is used as the indicator of treatment expenses, there is a need to tackle factors that influence the LOS of stroke patients for each disease group who are divided based on whether surgery is performed or not for the proper management of the LOS.     

驻京7所军队医院平均住院日调查

目的 科学评估7所医院各科室平均住院日,树立标杆,找出各医院平均住院日相对较高的科室.方法 对比分析各医院年度院级和科级平均住院日,剖析医院平均住院日内部构成比,计算各专业住院日平均值.结果 各医院出院患者构成有差异,部分科室平均住院日差别较大.结论 住院患者构成影响医院整体平均住院日,各医院部分科室平均住院日仍有压缩空间.