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首页> 外文期刊>Journal of Health Services Research & Policy >Do English NHS waiting time targets distort treatment priorities in orthopaedic surgery?
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Do English NHS waiting time targets distort treatment priorities in orthopaedic surgery?

机译：英语NHS的等待时间目标是否扭曲了整形外科的治疗重点？

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Objectives: To assess and quantify the impact of guarantees on maximum waiting times on clinical decisions to admit patients from waiting lists for orthopaedic surgery. nnMethods: Before and after comparative study, analysing changes in waiting times distributions between 1997/8 and 2001/2 for waiting list and booked inpatients and day cases admitted for elective treatments in trauma and orthopaedics in English hospitals. nnResults: The 2001/2 maximum waiting time target of 15 months did change the pattern of admissions for trauma and orthopaedic elective inpatients, with a net increase in admissions in that year, compared with 1997/8 (and over and above the 30,259 (7.6%) overall increase in all admissions) of patients who had waited around 15 months, of 9333. There was little indication that these additional admissions displaced shorter wait patients. In absolute and proportional terms, admissions increased for all waiting time categories except very short waiters – one to two weeks (an absolute fall of 2901 and a relative fall of 6591), and those waiting 40–41 weeks. The latter fall was only 111 patients in absolute terms (or 577 relative to the expected increase), however. The former much larger reduction may be an indication of clinical distortions, but it is unclear why very short wait (presumably more urgent) patients should disproportionately suffer compared with longer wait (presumably less urgent) cases. In addition, there was little indication that more minor cases usurped more major cases: 57% of the increase consisted of knee and hip replacement procedures, for example. nnConclusions: While the 2001/2 waiting times target demonstrably changed admission patterns (and was a major contribution to the reduction in long waits), the extent to which this represented significant and clinically relevant distortions is questionable given the lack of widely accepted admission criteria. However, as targets become progressively tougher, there is a need to monitor consultants' concerns more closely.
机译：目的：评估和量化保证对最大等待时间的影响对临床决策的影响，以使患者从骨科手术的等待名单中入院。 nn方法：比较研究之前和之后，分析1997年8月至2001年2月之间等待名单和预订住院病人的住院时间和日间病例的等待时间分布的变化，这些患者在英国医院接受创伤和骨科的选择性治疗。结果：2001/2的最大等待时间目标为15个月，确实改变了创伤和骨科择期住院病人的入院方式，与1997/8（以及30,259以上（7.6以上）相比，该年的入院人数净增加）在15个月左右等待等待的患者的全部入院总数（3333），共9333人。几乎没有迹象表明，这些额外的入院率替代了等待时间较短的患者。从绝对和成比例的角度来看，除了非常短的侍者外，所有等待时间类别的入学人数都增加了，只有一到两周（绝对下降2901，相对下降6591），以及等待40-41周的人。然而，以绝对值计算，后者仅下降了111名患者（相对于预期的增长577名）。前者的大幅度减少可能表明临床扭曲，但目前尚不清楚为何与等待时间较长（可能较不紧急）的患者相比，等待时间短（可能更为紧急）的患者应成比例地遭受痛苦。此外，几乎没有迹象表明更多的次要病例会取代更多的大病例：例如，增加的57％包括膝关节和髋关节置换手术。 nn结论：尽管2001/2轮候时间目标明显改变了入院模式（这是减少长时间轮候的主要贡献），但由于缺乏广泛接受的入院标准，这在很大程度上代表了临床上的重大扭曲。但是，随着目标变得越来越严格，有必要更加密切地监视顾问的关注。

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