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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Impact of a health maintenance organization hospitalist system in academic pediatrics.
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Impact of a health maintenance organization hospitalist system in academic pediatrics.

机译：健康维护组织住院医生系统对小儿科的影响。

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OBJECTIVE: Hospitalist systems decrease length of stay (LOS) and cost for hospitalized adults. Whether hospitalist systems decrease LOS and cost for hospitalized children has not been conclusively established. We wanted to determine whether a health maintenance organization's (HMO's) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents' ratings of care. DESIGN: Interrupted time-series study of general pediatric patients admitted to a freestanding pediatric teaching hospital from 1993 to 1998. The intervention group consisted of all patients admitted to a staff model not-for-profit HMO that began using hospitalists in October 1996. Patients in other HMOs and traditional insurance groups were studied for comparison. The main outcomes were mean LOS and inflation-adjusted costs. Other outcomes included parents' ratings of care and mortality, readmission, and follow-up rates. RESULTS: Immediately after the introduction of the hospitalist system, mean LOS for staff model not-for-profit HMO fell 12% (0.3 days), and mean cost of hospitalization decreased 16% (Dollars 217) compared with prehospitalist levels. Parental ratings of care, initially somewhat low, improved substantially. Seven-day follow-up rates, mortality, and readmission rates did not change. Comparison groups experienced no concurrent improvements in LOS, cost, parental ratings, mortality, or readmission rates. CONCLUSIONS: A pediatric hospitalist system within a staff-model HMO significantly improved LOS, cost, and parental ratings of care without affecting rates of posthospitalization follow-up. Additional studies are needed both to measure broader aspects of quality and to assess the impact of such a program on patients being cared for through other types of delivery and insurance systems.
机译：目的：医院系统减少住院时间（LOS）并降低住院成年人的费用。尚未最终确定医院系统是否可以降低住院儿童的服务水平和成本。我们想确定健康维护组织（HMO）对儿科住院医生系统的实施是否会影响服务水平，成本，死亡率，再入院率，随访率以及父母的护理等级。设计：从1993年至1998年间，对独立的儿科教学医院收治的普通儿科患者进行的时间序列研究中断。干预组包括所有在1996年10月开始使用住院医生的非营利性HMO员工模型患者。对其他HMO和传统保险集团中的人进行了比较研究。主要结果是平均LOS和通货膨胀调整后的成本。其他结果包括父母对护理和死亡率的评估，再入院率和随访率。结果：在采用住院医生制度后，与住院前的水平相比，员工模型非营利性HMO的平均LOS下降了12％（0.3天），平均住院费用下降了16％（美元217）。最初对父母的照顾等级较低，但是有了很大的提高。七天的随访率，死亡率和再入院率没有变化。比较组的LOS，费用，父母评分，死亡率或再入院率均未同时改善。结论：在工作人员模型HMO中的儿科住院医生系统显着改善了LOS，费用和父母对医疗的评价，而不会影响住院后的随访率。需要进行其他研究，以衡量更广泛的质量，并评估该计划对通过其他类型的分娩和保险系统所护理的患者的影响。

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