Migration of Patients Between Five Urban Teaching Hospitals in Chicago
Migration of Patients Between Five Urban Teaching Hospitals in Chicago
复制标题
DOI：
10.1007/s10916-013-9930-y
复制
发表时间：
2013-04-01
影响因子：
5.3
通讯作者：
Lambert, Bruce L.
中科院分区：
文献类型：
--
作者：
Galanter, William L.;Applebaum, Andrew;Lambert, Bruce L.
量化芝加哥一组医院出院患者的患者共享程度和住院护理碎片化程度。5家医院2年内的入院出院日期和患者邮政编码与加密算法相匹配。入住一家以上的医院被认为是分散治疗。利用2000年美国人口普查的邮政编码数据，测量了碎片化与社会经济变量之间的关系。使用一家医院的验证，使用加密标识符的患者匹配灵敏度为99.3%，特异性为100%。该队列包含228,151名独特患者和334,828名入院患者。大约2%的患者接受了分散的护理，占入院人数的5.8%和住院天数的6.4%。在5家医院中的3家，总体而言，接受碎片化护理的患者的住院时间比没有接受碎片化护理的患者更长。分散程度因医院而异，并与非白种人的比例、收入落在最低四分位数的居民比例以及患者所在邮政编码地区有更多孩子由母亲独自抚养的居民比例有关。接受零散护理的患者占住院天数的6.4%。由于并非所有区域医院都参与了这项工作，因此这一比例对我们区域来说是一个较低的估计，但这一比例高到足以表明在建立卫生信息交流方面的价值。分散程度因医院、人均收入、种族和单身母亲家庭比例而异。这种安全的方法和碎片分析可能对未来的分析有用。
To quantify the extent of patient sharing and inpatient care fragmentation among patients discharged from a cohort of Chicago hospitals. Admission and discharge dates and patient ZIP codes from 5 hospitals over 2 years were matched with an encryption algorithm. Admission to more than one hospital was considered fragmented care. The association between fragmentation and socio-economic variables using ZIP-code data from the 2000 US Census was measured. Using validation from one hospital, patient matching using encrypted identifiers had a sensitivity of 99.3 % and specificity of 100 %. The cohort contained 228,151 unique patients and 334,828 admissions. Roughly 2 % of the patients received fragmented care, accounting for 5.8 % of admissions and 6.4 % of hospital days. In 3 of 5 hospitals, and overall, the length of stay of patients with fragmented care was longer than those without. Fragmentation varied by hospital and was associated with the proportion of non-Caucasian persons, the proportion of residents whose income fell in the lowest quartile, and the proportion of residents with more children being raised by mothers alone in the zip code of the patient. Patients receiving fragmented care accounted for 6.4 % of hospital days. This percentage is a low estimate for our region, since not all regional hospitals participated, but high enough to suggest value in creating Health Information Exchange. Fragmentation varied by hospital, per capita income, race and proportion of single mother homes. This secure methodology and fragmentation analysis may prove useful for future analyses.