丹麦急诊科重组前后的再入院趋势。

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES Journal of Health Services Research & Policy Pub Date : 2023-01-01 DOI:10.1177/13558196221108894
Søren Bie Bogh, Marianne Fløjstrup, Sören Möller, Mickael Bech, Annmarie T Lassen, Mikkel Brabrand, Christian B Mogensen
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引用次数: 1

摘要

目的:为了实现更好和更有效的紧急医疗保健,丹麦公立医院系统进行了重新配置,将医院紧急护理集中到广泛和专门的急诊科。本文研究了这种重新配置如何影响患者再入院率。方法:我们纳入了2007年1月1日至2017年12月24日在丹麦四个地理区域的公立非精神病院的所有计划外住院患者(年龄≥18岁)。使用中断时间序列设计,我们检查了再入院率的趋势变化。在分析整体效果的基础上,根据入院时间、工作日/周末进行分层分析。根据患者特征和其他系统变化对分析结果进行了调整。结果:7天再入院率从2007年的2.6%上升至2017年的3.8%,30天再入院率从8.1%上升至11.5%。然而,这一比率比没有进行重新配置时的比率要低。重新配置使7天再入院率每年降低1.4%(风险比[CI 95%] 0.986[0.981-0.991]), 30天再入院率每年降低1%(风险比[CI 95%] 0.99[0.987-0.993])。结论:重构降低了再入院率,但在整个研究期间再入院率仍在增加。医院和政策制定者似乎需要找到进一步减少病人负担的方法。
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Readmission trends before and after a national reconfiguration of emergency departments in Denmark.

Objective: In order to achieve better and more efficient emergency health care, the Danish public hospital system has been reconfigured, with hospital emergency care being centralised into extensive and specialised emergency departments. This article examines how this reconfiguration has affected patient readmission rates.

Methods: We included all unplanned hospital admissions (aged ≥18 years) at public, non-psychiatric hospitals in four geographical regions in Denmark between 1 January 2007 and 24 December 2017. Using an interrupted time-series design, we examined trend changes in the readmission rates. In addition to analysing the overall effect, analyses stratified according to admission time of day and weekdays/weekends were conducted. The analyses were adjusted for patient characteristics and other system changes.

Results: The seven-day readmission rate increased from 2.6% in 2007 to 3.8% in 2017, and the 30-day rate increased from 8.1% to 11.5%. However, the rates were less than what they would have been had the reconfiguration not been introduced. The reconfiguration reduced the seven-day readmission rate by 1.4% annually (hazard ratio [CI 95%] 0.986 [0.981-0.991]) and the 30-day rate by 1% annually (hazard ratio [CI 95%] 0.99 [0.987-0.993]).

Conclusions: Reconfiguration reduced the rate of increase in readmissions, but nevertheless readmissions still increased across the study period. It seems hospitals and policymakers will need to identify further ways to reduce patient loads.

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来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
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