Carrot and sticks? The Community Care Act (2003) and the effect of financial incentives on delays in discharge from hospitals in England
Carrot and sticks? The Community Care Act (2003) and the effect of financial incentives on delays in discharge from hospitals in England
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DOI：
10.1093/pubmed/fdm026
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发表时间：
2007-09-01
影响因子：
4.4
通讯作者：
Bianchessi, C.
中科院分区：
文献类型：
--
作者：
McCoy, D.;Godden, S.;Bianchessi, C.
背景的信念，许多延迟出院是由社会服务部门（SSD）导致社区护理法2003年给NHS医院在英格兰的权力，以收取SSDs.Methods我们调查了150 SSDs在英格兰有关该法案的实施情况，并使用常规数据来分析延迟出院患者的数量的趋势;的数量和原因延迟出院床天的部门;和住院天数的比例，包括延迟discharge.Findings大多数医院选择不收取SSD延迟。在2004/05年度和2005/06年度，几乎三分之二的SSD（62%）没有向急性医院支付任何形式的费用，他们更愿意合作。“延迟出院患者”人数的下降是2003年法案实施前的一个长期趋势。2004/05年度，延迟出院天数占所有住院天数的1.58%。与流行的观点相反，NHS占三分之二（67%）的床日延迟，缺乏合适的替代NHS提供和服务是一个关键因素。病人出院的人数越来越多，而且在急性期后的恢复期也越来越早。然而，关于提前出院的质量和安全问题。例如，紧急再入院率从2002/03年的5.4%上升到2005/06年的6.7%，病人的不满是显着的。结论虽然延迟出院急性医院病床下降，出院的质量和能力的初级保健信托基金（PCT）和SSD，以确保适当和充分的出院后护理是不应该的。与普遍的看法相反，社会服务的延误不如国民保健制度造成的延误那么重要。没有证据支持政府对SSD延迟收费的政策。其他因素，包括国民保健服务的提供，是重要的，和一个全面的卫生和社会保健的概述是至关重要的。
Background The belief that many delays in discharge from hospital were caused by social service departments (SSDs) led to the Community Care Act 2003 giving NHS hospitals in England the power to charge SSDs.Methods We surveyed 150 SSDs in England about the implementation of the Act and used routine data to analyse trends in the number of delayed discharge patients; the number and cause of delayed discharge bed days by sector; and the proportion of inpatient bed days that consisted of delayed discharges.Findings Most hospitals opted not to charge SSDs for delays. Almost two thirds of SSDs (62%) made no payment of any kind to an acute hospital in 2004/05 and 2005/06, preferring to work collaboratively. The fall in number of 'delayed discharge patients' is a long term trend which precedes the implementation of the 2003 Act. Delayed discharge bed days accounted for 1.58% of all inpatient bed days in 2004/05. Contrary to popular opinion, the NHS accounted for two thirds (67%) of bed day delays, lack of suitable alternative NHS provision and services is a key factor. Patients are being discharged in greater numbers and earlier in their post-acute recovery phase. There are however questions about the quality and safety of early discharge. For example, emergency hospital readmissions rates have risen from 5.4% in 2002/03 to 6.7% in 2005/06, and patient dissatisfaction is significant.Conclusion Although delays in discharge from acute hospital beds have fallen, the quality of discharge and the capacity of Primary Care Trusts (PCTs) and SSDs to ensure appropriate and adequate post-discharge care is not as it should be. Contrary to popular perception, social services delays are of less significance than delays attributable to the NHS. There is no evidence to support government policy of charging SSDs for delay. Other factors, including NHS provision, are important, and a comprehensive overview of health and social care is vital.