Reducing length of stay for patients hospitalized with exacerbation of COPD by using a practice guideline
Reducing length of stay for patients hospitalized with exacerbation of COPD by using a practice guideline
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DOI：
10.1378/chest.111.1.89
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发表时间：
1997-01-01
期刊：
影响因子：
9.6
通讯作者：
Weingarten, S
中科院分区：
文献类型：
--
作者：
Kong, GK;Belman, MJ;Weingarten, S
临床实践指南已被推广为降低成本同时保持优质护理的有效方法。目的：研究缩短 COPD 恶化住院时间的实践指南。方法：我们回顾性研究实践指南，以确定因 COPD 恶化而出现并发症风险较低、因此可能适合早期出院的患者。然后，我们使用隔月干预和控制时间序列在 12 个月的时间内前瞻性地研究了该实践指南。结果：该实践指南在 250 名因 COPD 恶化而住院的连续患者中进行了回顾性研究。在 250 名患者中，237 名患者（94.8%）在住院 72 小时后被归类为低风险，可能适合出院。在前瞻性研究中，很少有患者（124 名患者中的 24 名或 19%）被确定执行该指南。然而，在那些被确定的患者中，住院时间没有统计学差异。数据还显示，干预组和对照组的住院时间在此期间都缩短了。 结论：某些实践指南在研究中可能看似有效，但在临床环境中应用时实际上可能缺乏有效性，甚至可能增加成本。我们证明了在建议广泛实施之前前瞻性评估临床实践指南的重要性。
Clinical practice guidelines have been promoted as an effective way of reducing costs while maintaining quality care.Objective: To study a practice guideline to shorten length of stay for patients hospitalized with exacerbation of COPD.Methods: We retrospectively studied a practice guideline to identify patients who were at low risk of complications from their exacerbation of COPD and hence potentially suitable for early hospital discharge. We then prospectively studied the practice guideline using an alternate month intervention and control time series over a period of 12 months.Results: The practice guideline was retrospectively studied in 250 consecutive patients hospitalized with exacerbation of COPD. Of the 250 patients, 237 patients (94.8%) were classified as low risk after 72 h of hospitalization and were potentially suitable for discharge. In the prospective study, few patients (24 of 124 or 19%) were identified for implementation of the guideline. However, in those patients who were identified, length of stay was not statistically different. The data also showed that length of stay for both intervention and control groups had shortened over this time.Conclusion: Certain practice guidelines may appear efficacious in studies but may actually lack effectiveness when applied in clinical settings and may even increase costs. We demonstrated the importance of prospectively evaluating clinical practice guidelines before recommending them for widespread implementation.