INAPPROPRIATE USE OF HOSPITALS IN A RANDOMIZED TRIAL OF HEALTH-INSURANCE PLANS
INAPPROPRIATE USE OF HOSPITALS IN A RANDOMIZED TRIAL OF HEALTH-INSURANCE PLANS
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DOI：
10.1056/nejm198611133152005
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发表时间：
1986-11-13
影响因子：
158.5
通讯作者：
BROOK, RH
中科院分区：
文献类型：
--
作者：
SIU, AL;SONNENBERG, FA;BROOK, RH
我们考察了不适当住院率的地域差异以及费用分担对该比率的影响。在一项医疗保险计划的随机试验中，1132名成年人的医疗记录被两名对患者的保险计划视而不见的医生审查。他们认为23%的入院是不合适的，另外17%的入院是可以通过使用门诊手术来避免的。不适当录取的比例在六个网站之间有所不同(从10%到35%)，但总录取率较低的地区不一定有较低的不适当录取比例。在所有服务的费用分摊计划中，22%的入院人数和34%的住院日被归类为不适当，而在向患者免费提供护理的计划中，24%的入院人数和35%的住院日被归类为不适当(这些差异在统计学上没有显著意义)。我们的数据显示，很大一部分住院治疗是潜在的可以避免的。由于费用分担并没有选择性地减少不适当的住院，因此开发其他机制来做到这一点很重要。
We examined geographic variation in the rate of inappropriate hospitalization and the effect of cost sharing on that rate. The medical records of 1132 adults hospitalized in a randomized trial of health insurance plans were reviewed by two physicians who were blinded to the patients'' insurance plan. They judged 23 percent of the admissions to be inappropriate and an additional 17 percent to have been avoidable by the use of ambulatory surgery. The percentage of inappropriate admissions varied among six sites (from 10 to 35 percent), but areas with low total admission rates did not necessarily have low proportions of inappropriate admissions. In plans with cost sharing for all services, 22 percent of admissions and 34 percent of hospital days were classified as inappropriate, as compared with 24 percent of admissions and 35 percent of hospital days in the plan under which care was free to the patient (these differences were not statistically significant). Our data show that a substantial fraction of hospitalization is potentially avoidable. Because cost sharing did not selectively reduce inappropriate hospitalization, it is important to develop other mechanisms to do so.