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。     

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.     

The effects of air pollution on length of hospital stay for adult patients with asthma

Length of hospital stay (LOS) of asthma can be a reflection of the disease burden faced by patients, and it is also sensitive to air pollution. This study aims at estimating and validating the effects of air pollution and readmission on the LOS for those who have asthma, considering their readmission history, minimum temperature, and threshold effects of air pollutants. In addition, sex, age, and season were also constructed for stratification to achieve more precise and specific results. The results show that no significant effects of PM_2.5 and NO₂ on LOS were observed in any of the patients, but there were significant effects of PM_2.5 and NO₂ on LOS when a stratifying subgroup analysis was performed. The effect of PM₁₀ on LOS was found to be lower than that of PM_2.5 and higher than that of NO₂. SO₂ did not have a significant effect on LOS for patients with asthma in our study. Our study confirmed that the adverse effects of air pollutants (such as PM₁₀) on LOS for patients with asthma existed; in addition, these effects vary for different stratifications. We measured the effects of air pollutants on the LOS for patients with asthma, and this study offers policy makers quantitative evidence that can support relevant policies for health care resource management and ambient air pollutants control.     

Estimating mean hospital cost as a function of length of stay and patient characteristics

Statistical models have been used to assess the influence of clinical and demographic factors on hospital charge and length of stay (LOS). Hospital costs constitute a significant proportion of overall expenditure in health care. With escalating costs, knowing the correlates of LOS and in-hospital cost is important for decisions on allocating resources. However, hospital charge and LOS are correlated. We describe two regression models that permit estimation of mean charges as a function of patient hospital stay and adjust for the influence of patient characteristics and treatment procedures on LOS and charge. In the first model, the mean charge over a specified duration is a weighted average of the expected cumulative charge, with weighting determined by the distribution of LOS. The second model for LOS and charge explicitly accounts for their correlation and yields estimates of the average charge per average LOS. The methods are applied to assess mean charges and mean charge per day by cardiac procedure in a cohort of patients hospitalized for acute myocardial infarction, while adjusting for the impact of patient demographic and clinical factors on LOS and charge. For relatively short hospital stays, and when only total hospital charges are available, these models provide a flexible approach to estimating summary measures on resource use while controlling for the effects of covariates on LOS and charge.     

Concurrent prediction of hospital mortality and length of stay from risk factors on admission

OBJECTIVE: To develop a method for predicting concurrently both hospital survival and length of stay (LOS) for seriously ill or injured patients, with particular attention to the competing risks of death or discharge alive as determinants of LOS. DATA SOURCES: Previously collected 1995-1996 registry data on 2,646 cases of injured patients from three trauma centers in Maine. STUDY DESIGN: Time intervals were determined for which the rates of discharge or death were relatively constant. Poisson regression was used to develop a model for each type of terminal event, with risk factors on admission contributing proportionately to the subsequent rates for each outcome in each interval. Mean LOS and cumulative survival were calculated from a combination of the resulting piecewise exponential models. PRINCIPAL FINDINGS: Age, Glasgow Coma Scale, Abbreviated Injury Scores, and specific mechanisms of injury were significant predictors of the rates of death and discharge, with effects that were variable in different time intervals. Predicted probability of survival and mean LOS from the model were similar to actual values for categorized patient groups. CONCLUSIONS: Piecewise exponential models may be useful in predicting LOS, especially if determinants of mortality are separated from determinants of discharge alive.     

老年营养风险指数与老年癌症及非癌症患者住院时间的关系研究

目的 应用老年营养风险指数(GNRI)评估患者的营养风险,探讨其与老年癌症及非癌症患者住院时间的关系。方法 选择老年住院患者37 267例,将其分为癌症组和非癌症组,应用GNRI评估患者入院时的营养风险;以患者死亡及出院为观察终点,住院时间(d)作为临床结局指标,采用边际结构模型探讨GNRI与老年癌症及非癌症患者住院时间的关联性。结果 超过一半(56.3%)的老年住院患者具有不同程度的营养风险;与非癌症患者相比,癌症患者GNRI水平(91.0±10.2)及无营养风险患者的比例(26.8%)更低,而具有低(24.6%)、中(29.0%)、高(19.7%)营养风险患者的比例均更高,差异均具有统计学意义(P＜0.05)。在控制其他混杂因素后,边际结构模型分析结果显示在癌症和非癌症患者中,住院时间均随营养风险程度的升高而延长,具有高营养风险的癌症患者住院时间最长,高达19.1(95% CI:17.5~20.8)d;在不同的营养风险分组中,癌症患者住院时间(14.5~19.1 d)均高于非癌症患者(10.1~15.2 d),差异均具有统计学意义(P＜0.05)。结论 GNRI 适用于老年癌症及非癌症患者的营养风险筛查评估,由GNRI评估的营养风险越高,患者住院时间越长。     

Analysis of hospital length of stay and discharge destination using hazard functions with unmeasured heterogeneity

The hospital length-of-stay and the discharge destination of a Medicare patient are the outcomes of one decision process involving the interests of the patient, the hospital, and the firms offering covered post-hospital care. We use a competing risk hazard estimation procedure and adjust for unobserved heterogeneity with a non-parametric technique to identify significant factors in the decision process. A patient's health and socio-economic characteristics, the availability of informal care, local market area conditions, and Medicare policies influence length-of-stay and discharge destination. The substitution we find between hospital and post-hospital care and among post-hospital care alternatives has policy implications for Medicare.     

平均住院日影响因素实证分析

目的：研究平均住院日的影响因素及作用强度,为中国医院合理利用医疗资源提供参考依据。方法：以2003年北京市6所三甲医院的100 259个住院病人的病案首页数据为研究对象,结合Anderson模型,运用负二项回归对住院日的影响要素进行实证分析。结果：前定变量中除了婚姻状况外,其他前定变量、使能变量、需要变量对平均住院日都有显著性影响。敏感度分析结果显示了较好的稳健性。结论：医院在制定降低平均住院日策略时需要考虑前定变量、使能变量、需要变量这些因素的影响。     

Influence of length of stay on patient satisfaction with hospital care in Japan.

OBJECTIVE: The objective of this study was to identify specific patient satisfaction items related to overall satisfaction by different length of stay (LOS) for patients in Japanese hospital settings. METHODS: This cross-sectional study involved a participant sample, drawn from 77 voluntarily participating hospitals throughout Japan, of in-patients discharged to the community. Older patients and psychiatric, pediatric, obstetric and gynecologic patients were excluded. The 1050 respondents analyzed (response rate > or = 5l.1%) were divided into three groups based on their LOS: group 1, LOS < or = 1 week; group 2, LOS < or = 1 month; and group 3, LOS > 1 month. Using stepwise multiple regression analysis, we explored for each LOS group the relationship between overall patient satisfaction and satisfaction with 33 individual items, including three regarding perceived reputation of the hospital in question. RESULTS: Some unique satisfaction items for each group (e.g. 'skill of nursing care' in group 1, 'Recovery of physical health', 'skill of nursing care', and 'respect for patients opinions and feelings' in group 2, and 'relief from pain' and 'respect for patients' opinions and feelings' in group 3) were significantly associated with overall satisfaction. In all three groups, common items (e.g. 'recovery from distress and anxiety' and 'doctor's clinical competence') also related significantly to overall satisfaction. Two items pertaining to the hospital reputation dimension (e.g. 'family member's evaluation of the hospital' and 'hospital reputation among other patients') were also significant predictors of overall satisfaction in all three groups. CONCLUSION: The findings show that according to LOS, unique items could determine significantly the achievement of overall satisfaction, while some common predictors across all three LOS groupings also seemed to be indispensable for inpatient's assessment of hospital care. It was also confirmed in this study that a positive perception of hospital reputation might have an important role in patient satisfaction in Japan.     

Hospital stay length as an effect modifier of other risk factors for nosocomial infection

This paper addresses the problem of hospital stay length as a risk factor for nosocomial infection and as a modifier of the effect of other risk factors for hospital infection. Patients were selected form two cross-sectional studies done in two different seasons of 1986. Risk of infection rose fairly steadily as hospital stay lenght increased (correlation coefficient: 0,83, p<0.01). Several risk factors (operation, underlying disease, and age) were analyzed on the basis of 1) raw data and 2) data stratified by lenght of stay. The results showed that hospital stay lenght is a strong modifier of the remaining risk factors, generally reducing, their effect on the development of hospital infection as length of stay increases.Corresponding author.     

The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition

Background: The prevalence of malnutrition in the hospitalized setting is 30% to 55%. Previous studies reported an association of malnutrition with an increased hospital length of stay (LOS), morbidity, and mortality of patients. This study evaluated the role of early nutrition intervention on LOS, diagnosis coding of malnutrition cases, calculating case mix index, and reducing delays in implementing nutrition support to patients. Methods: Demographic data, anthropometric measurements, LOS, and serum albumin levels were collected from 400 patients in 2 medical wards to determine the prevalence of malnutrition and potential delays in nutrition consultation. Based on these results, a nutrition intervention study was conducted in 1 ward; the other ward served as a control. Patients were classified as normally nourished or malnourished. Multivariate general linear regressions were used to reveal the impact of intervention on the change in LOS, controlling for other potential confounding factors on the cohort and a subset with severe malnutrition. Results: Of the 400 patients assessed, 53% had malnutrition. Multiple general linear regressions showed that nutrition intervention reduced LOS an average of 1.93 days in the cohort group and 3.2 days in the severe malnourished group. Case mix index and female gender were positively associated with LOS in the malnourished group. Nutrition intervention reduced the delays in implementing nutrition support to patients by 47%. Conclusions: Results highlight the positive impact of nutrition intervention in terms of reduced LOS in malnourished hospital patients. Reduction in LOS with diagnosis coding of malnutrition cases yielded substantial economic benefits.     

Malnutrition at Hospital Admission—Contributors and Effect on Length of Stay

Background: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS. Materials and Methods: This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization. Results: One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%–48%) were malnourished, and based on BMI, 32% (95% CI, 29%–35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1–117) days. After controlling for demographic, socioeconomic, and disease‐related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62–0.86). Other nutrition‐related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor. Conclusion: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age‐related social factors are contributors.     

上海市某医院股骨头坏死病人不适当住院日研究

入院及住院日适当性评价方案是基于医疗和技术标准的、独立于各病种的评价工具,在诊断不明确或不正确的情况下也能使用。评价住院日是否适当的方法是对每份病案进行回溯性评价,对病人住院的每一天进行考察,如果该天符合标准中的某一项,则该天的住院是合适的,如果不符合任何一项,则是不合适的。对2007年全年股骨头坏死出院病人,共计351例进行住院日适当性评价。     

医院感染对患者住院费用和住院时间的影响

目的分析医院感染对患者住院费用和住院时间的影响。方法对某院呼吸和血液内科患者,采用1∶1配对方法,比较医院感染者(感染组)与未感染者(对照组)之间住院费用和住院时间的差别。结果感染组住院费用平均高出对照组6 512.42元/人(P<0.05),平均住院日高出8.47 d(P<0.01)。结论医院感染导致患者住院费用增加和住院时间延长。     

Decreasing length of maternal hospital stay is not associated with increased readmission rates

Objective: To investigate changes in maternal length of postnatal stay by mode of birth and hospital type, and examine concurrent maternal readmission rates and reasons for readmission. Methods: Linked birth and hospital separation data were used to investigated mothers’ birth admissions (n=597,475) and readmissions (n=19,094) in the six weeks post‐birth in New South Wales, 2001–2007. Outcomes were postnatal length of stay (mean days) and rate of readmission per 100 deliveries. Poisson regression was used to investigate annual readmission rates and Wilcoxon‐Mann‐Whitney test was used to compare length of readmission stays. Results: The overall mean postnatal length of stay declined from 3.7 days in 2001 to 3.4 days in 2007. Private hospitals had longer stays after Caesarean and vaginal deliveries, but mean length of stay fell for both private and public hospitals, and both modes of birth. The maternal readmission rate fell from 3.4% in 2001 to 3.0% in 2007. Leading primary diagnoses at readmission following vaginal birth were postpartum haemorrhage and breast/ lactation complications and following Caesarean section were wound complications and breast/ lactation complications. Conclusions: Despite the decrease in mean length of stay for birth admissions, there was no increase, and in fact a decrease, in the rate of postnatal readmissions. Implications: Current practices in hospital length of stay and care for women giving birth do not appear to be having serious adverse health effects as measured by readmissions.     

相位角预测手术病人营养风险及住院时间

目的:探讨生物电阻抗相位角(phase angle,PA)与胸外手术病人营养风险、住院时间(hospital length of stay,LOS)的关系。方法:60例胸部手术病人,应用营养风险筛查2002(NRS2002)、主观全面评定(Subjective Global Assessment,SGA)、白蛋白、人体成分分析、PA评价其营养风险及LOS。结果 :与对照组比较,手术病人PA偏低,男(6.0±1.0)vs(3.85±1.0),女(5.4±0.9)vs(4.9±0.6),P0.01。与正常PA比较,低PA者营养风险相对危险度,用NRS2002。无风险(RR 2.8,95%CI=1.2~6.9),中度风险(RR 3.9,95%CI=1.8~8.6),重度风险(RR4.2,95%CI=2.0~8.7);用SGA。营养良好(RR 2.5,95%CI=0.9~6.9),中度营养不良(RR 4.4,95%CI=2.1~9.4),重度营养不良(RR 3.9,95%CI=1.9~8.0),与NRS2002相似;与正常PA比较,低PA者住院时间倾向于延长(LOS≥21 d,RR=4.4,95%CI=2.2~8.8)。结论 :低PA与手术病人营养风险、LOS延长密切关联。PA测量有助于快速明确病人的营养风险对于确定病人营养干预和判断疾病转归提供了客观依据。