اقامت غیر ضروری بیماران در بیمارستان‌های ایران: مرور نظام مند و متاآنالیز

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه علوم مدیریت و اقتصاد بهداشت دانشگاه علوم پزشکی تهران

2 استادیار گروه مدیریت و اقتصاد بهداشت.گروه مدیریت و اقتصاد بهداشت، دانشکده بهداشت، دانشگاه علوم پزشکی زابل، زابل، ایران.

چکیده

زمینه و هدف: کاهش مدت اقامت نامناسب بیماران در بیمارستان‌ها موجب ارتقای کارایی بیمارستان‌ها می‌شود. هدف این پژوهش شناسایی متوسط اقامت نامناسب بیماران در بیمارستان‌های کشور و عوامل مؤثر بر آن بوده است.
روش کار: برای انجام این پژوهش مروری منظم، کلیه مقالات مرتبط با سنجش متوسط اقامت نامناسب بیمار در بیمارستان‌های ایران منتشر شده در بازه زمانی (۱۳۸۵-۱۳۹۶) در ۸ پایگاه داده‌ای جستجو، جمع‌آوری و ارزیابی کیفیتی شدند. در نهایت، تعداد ۱۳ مقاله با استفاده از نرم افزارComprehensive Meta-Analysis تحلیل شدند.
نتایج: در این مطالعه، میزان بروز متوسط اقامت نامناسب در بیمارستان‌های ایران ۵.۴ درصد (۱۱.۴-۲.۴درصد: حدود اطمینان 95%) به دست آمد. بیشترین میزان متوسط اقامت نامناسب بیماران در تهران در سال ۱۳۹۴ با ۴۹.۰ درصد ۶۲.۵-۳۵.۷ درصد: حدود اطمینان۹۵%) و کمترین میزان متوسط اقامت نامناسب بیماران در شیراز در سال ۱۳۸۹ با ۰.۵ درصد (۱.۱-۰.۲درصد: حدود اطمینان۹۵%) به دست آمد. عوامل مربوط به بیمار، پزشک و بیمارستان منجر به بروز متوسط مدت اقامت نامناسب بیماران در بیمارستان شده است. متوسط اقامت نامناسب به ترتیب منجر به افزایش هزینه، افزایش زمان انتظار سایر بیماران و کاهش کیفیت خدمات شده بود. مهم‌ترین راهکارهای کاهش مدت اقامت نامناسب، اصلاح نظام بیمه و شیوه پرداخت، گسترش خدمات سرپایی و اصلاح عملکرد سیستم ارجاع بیماران بود.
نتیجه گیری: میزان متوسط اقامت نامناسب بیماران در بیمارستان‌های ایران تقریباً بالا است. بنابراین، سیاستگذاران و مدیران نظام سلامت باید اقدامات جدی به منظور کاهش میزان بروز متوسط اقامت نامناسب در بیمارستان‌ها بکار گیرند.
واژگان کلیدی: متوسط اقامت نامناسب، مرور نظام مند، متاآنالیز، بیمارستان، ایران

کلیدواژه‌ها


 
1- Barnum H, Kutzin J. Public hospitals in developing countries: resource use, cost, financing. Baltimore: Johns Hopkins University Press; 1993.
 
2-Mosadeghrad AM. Patient choice of a hospital: Implications for health policy and management, International Journal of Health Care Quality Assurance, 2014; 27 (2): 152-164.
 
3-Mosadeghrad AM. A conceptual framework for quality of care.  Mat Soc Med. 2012; 24(4): 251-261.
 
4-Mosadeghrad AM, Esfahani P, Nikafshar M. Hospitals’ efficiency in Iran: A Systematic Review and Meta-Analysis of Two Decades of Research, 2017. 11(3). 318-31.
 
5-Mosadeghrad, A.M. Handbook of hospital professional organization and management (2), Tehran: Dibagran Tehran, Iran. 2004: 30-54[Persian].
 
6-Soria-Aledo V, Carrillo-Alcaraz A, Flores-Pastor B, Moreno-Egea A, Carrasco-Prats M, Aguayo-Albasini JL. Reduction in inappropriate hospital use based on analysis of the causes. BMC health services research. 2012; 12(1):361.
 
7-Pileggi C, Bianco A, Di Stasio SM, Angelillo IF. Inappropriate hospital use by patients needing urgent medical attention in Italy. Public health. 2004; 118(4): 284-91.
 
8-Panis LJ, Kolbach DN, Hamulyák K, Prins MH. Identifying inappropriate hospital stay in patients with venous thromboembolism. European journal of internal medicine. 2004;15(1):39-44.
 
9-Pourreza A, Kavosi Z, Khabiri R, Salimzadeh H. Inappropriate admission and hospitalization in teaching hospitals of Tehran university of medical sciences. Pak J Med Sci , 2008; 24 (2): 301-305.
 
10-Meidani Z, Farzandipour M, Gilasi H, Shekrachi M, Nazemibidgoli Z. Investigation of Appropriateness of Patient Hospitalization Based on Appropriateness Evaluation Protocol (AEP). payavard. 2016; 10 (4) :360-369[Persian].
 
11-Hatam N, Askarian M, Sarikhani Y, Ghaem H. Necessity of admissions in selected university affiliated and private hospitals during 2007 in Shiraz. Arch Iran Med. 2010; 13(3):230–4.
 
12-Tavakoli N, Yasinzadeh M, Nejad M. Evaluation of appropriate and inappropriate admission and hospitalization days according to Appropriateness Evaluation Protocol (AEP). Archives of Iranian medicine. 2015; 18(7):430-4.
 
13-Meidani Z, Farzandipour M, Farokhian A, Haghighat M, Nazemi Bidgoli Z. Laboratory Utilization Review as a Trigger for Hospital Quality Improvement. payavard. 2017; 10 (6) :496-503.
 
14-OECD Health Statistics: Health care utilisation. Length of hospital stay, 2017. Avaliable from: https://data.oecd.org/healthcare/length-of-hospital-stay.htm.
 
15-Iran Ministry of health and medical education, Treatment deputy. Patient Length of stay in hospital. 2018[Persian].
 
16-Hartz A, Bade P, Sigmann P, Guse C, Epple P, Goldberg K. The evaluation of screening methods to identify medically unnecessary hospital stay for patients with pneumonia. Int J Qual Health Care. 1996; 8(1): 3 – 11.
 
17-Stricker K, Rothen HU, Takala J. Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand 2003; 47(5): 508-15.
 
18-Gruenberg D, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G. Factors influencing length of stay in the intensive care unit. Am J Crit Care 2006; 15(5): 502-9.
 
19-Castaldi S, Ferrari MR, Sabatino G, Trisolini R, Auxilia F. [Evaluation of the appropriateness of hospital use: the case of IRCCS Ospedale Maggiore di Milano, Italy. Ann Ig. 2002; 14(5):399-408.
 
20-Mould-Quevedo JF, García-Peña C, Contreras-Hernández I, Juárez-Cedillo T, Espinel-Bermúdez C, Morales-Cisneros G, Sánchez-García S. Direct costs associated with the appropriateness of hospital stay in elderly population. BMC health services research. 2009; 9(1):151.
 
21-Hwang JI, Kim J, Jang W, Park JW. Inappropriate hospitalization days in Korean oriental medicine hospitals. Int J Qual Health Care. 2011; 23(4):437-44.
 
22-OECD/EU. Health at a Glance: Europe 2016: State of Health in the EU Cycle.
 
23-Hammond CL, Pinnington LL, Phillips MF. A qualitative examination of inappropriate hospital admissions and lengths of stay. BMC health services research. 2009; 9(1):44.
 
24-Lim SC, Doshi V, Castasus B, Lim JK, Mamun K. Factors causing delay in discharge of elderly patients in an acute care hospital. Ann Acad Med Singapore. 2006; 35:27–32.
 
25-Mahfoozpour S, Zarei E, Mehrabi Y, Ashkevari N. Evaluation of Unnecessary Admissions and Hospital Stays and Estimation of Its Financial Burden: A Study at Internal Wards of Selected Hospitals of Alborz University of Medical Sciences. Evaluation. 2017 Oct; 6(5): 51-58 [Persian].
 
26-Jeddian A, Afzali A, Jafari N. Evaluation of Appropriateness of Admission and Hospital Stay at Educational Hospital. Archives of Iranian medicine. 2017; 20(1):16-21.
 
27-Mitton C, Adair CE, McKenzie E, Patten SB & Waye Perry B. Knowledge transfer and exchange: Review and synthesis of the literature. Journal of Milbank Quarterly 2007; 85(4): 729-68.
 
28-Nabilo B, Mohbi E, Alinezhad A. utilizing of hospital beds in western Azerbaijan. Journal of Urmia Nursing and midwifery faculty. 2012. 4(39); 565-71[Persian].
 
29-Nikookar R, Ghaffari Sh, Akbari Kamrani AA, Sahaf R, Moghadam M, Ghadimi MR. Assessing the Duration of Unnecessary Hospitalization and Expenses in Older Individuals Suffering From Cerebral Vascular Accident in the Chronic Care Unit. Iranian Journal of Ageing. 2015; 10(2):180-187[Persian].
 
30-Barouni M, Amini S, Khosravi S. Appropriateness of Delivered Services in Educational Hospitals: A Case Study in Kerman University of Medical Sciences. Sadra Med Sci J 2016; 4(3): 185-194[Persian].
 
31-Fekari J, Ezzati M, Pakdaman M, Khalafi A. The Assessing of Inappropriate Admissions and Hospitalization based on Appropriate Evaluation Protocol in Alinasab hospital in Tabriz-2009. Journal of Hospital. 2011; 9(3):39-44[Persian].
 
32-Aghdam Bakhtiyari, Reazagoli V, Asghar M, Zahra K. Inappropritness Admissions and Inpatients in Imam Khomeini Hospital of Tabriz University of Medical Sciences. Research Journal of Biological Sciences. 2007; 2(4):468-71.
 
33-Eghbalkhah A, Salamati P, Sotoudeh K, Khashayar P. Evaluation and comparison of admission and discharge criteria in admitted patients’ of pediatric intensive care unit of bahrami children’s hospital with the criteria of American academy of pediatrics. Iranian Journal of Pediatrics. 2006;16(4):399-406.
 
34-Ghods A, Khabiri R, Raeisdana N, Ansari M, Motlagh NH, Sadeghi M, Zarei E. Predictors of inappropriate hospital stay: Experience from Iran. Global journal of health science. 2015 May; 7(3):82.
 
35-Celik Y, Celik SS, Bulut HD, Khan M, Kisa A. Inappropriate use of hospital beds: a case study of university hospitals in turkey. World Health Serv 2001; 37(1): 6-13.
 
36-Villatla J, Siso A, Cereijo AC, Sequeira E, De Lasierra A. Appropriateness of hospitalization in a short stay unit of a teaching hospital, a controlled study. Med Clin 2002; 122(2): 454-6.
 
37-Llopis Roca F, Juan Pastor A, Ferré Losa C, Martín Sánchez FJ, Llorens Soriano P, Sempere Montes G, et al. Register of short-stay units in Spain, the REGICE project, study 1: location, organizational features, and staffing. Emergencias 2014; 26:57–60.
 
38-Brand CA, Kennedy MP, King-Kallimanis BL, Williams G, Bain CA, Russell DM. Evaluation of the impact of implementation of a Medical Assessment and Planning Unit on length of stay. Australian Health Review. 2010 Aug 25;34(3):334-9.
 
39-Erik H. Hoyer, Michael Friedman, Annette Lavezza and et al. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. Research output: Contribution to journal, 2016. 11(5); 341-47.
 
40-Mihailovic N, Kocic S, Jakovljevic M. Review of diagnosis-related group-based financing of hospital care. Health services research and managerial epidemiology. 2016; 3: 1-8.
 
41-Theurl E, Winner H. The impact of hospital financing on the length of stay: evidence from Austria. Health Policy. 2007; 82(3):375-389.
 
42-Schwartz, M.H., Tartter, P.I. (1998). Decreased length of stay for patients with colorectal cancer: implications of DRG use. Journal for Healthcare Quality, 20(4):22–5.
 
43-Louis, D., Yuen, E.J., Braga, M. et al. (1999). Impact of a DRG-based hospital fi nancing system on quality and outcomes of care in Italy. Health Services Research, 34(1 Pt 2): 405–15.
 
44-da Silva EN, Powell-Jackson T. Does expanding primary healthcare improve hospital efficiency? Evidence from a panel analysis of avoidable hospitalisations in 5506 municipalities in Brazil, 2000–2014. BMJ global health. 2017;2(2):e000242.
 
45-Rosano A, Loha CA, Falvo R, Van der Zee J, Ricciardi W, Guasticchi G, De Belvis AG. The relationship between avoidable hospitalization and accessibility to primary care: a systematic review. The European Journal of Public Health. 2012; 29;23(3):356-60.
 
46-Juan A, Salazar A, Alvarez A, Perez JR, Garcia L, Corbella X. Effectiveness and safety of an emergency department short-stay unit as an alternative to standard inpatient hospitalisation. Emergency Medicine Journal. 2006 Nov 1;23(11):833-7.
 
47-Furlanetto TW, Barcelos DD, Faulhaber AM. A short stay unit decreased mean length of stay in a hospital in south Brazil. Clinical and biomedical research. Porto Alegre.2014, 34(4). p. 381-386.
 
48-Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, Lee TH. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001; 134:637-43.
 
49-Gertman PM, Restuccia JD. The apprpriateness evaluation protocol: A technique for assessing unnecessary days of hospital care. Medical care, 1981; 19 (8): 855-871.
 
50-Dukkers van Emden DM, Ros WJ, Berns MP. Transition of care: an evaluation of the role of the discharge liaison nurse in The Netherlands. J Adv Nurs, 1999; 30:1186–1194
 
51-Lang T, Liberati A, Tampieri A, Fellin G, Gonsalves MD, Lorenzo S, Pearson M, Beech R, Santos-Eggimann B. A European version of the appropriateness evaluation protocol: Goals and presentation. International journal of technology assessment in health care. 1999 Jan;15(1):185-97.
 
52-Sanchez E, Letona J, Gonzalez R, Garcia M, Darpon J, Garay JI. A descriptive study of the implementation of the EFQM excellence model and underlying tools in the Basque Health Service. Int J Qual Health Care. 2006;18(1):58–65.
 
53-Mosadeghrad, AM. Implementing strategic collaborative quality management in healthcare sector. International Journal of Strategic Change Management, 2012; 4, pp. 203-228.
 
54-Mosadeghrad AM, Ashrafi E. The effect of quality management on the efficiency of the respiratory intensive care unit in a hospital. SJSPH. 2018; 15 (4): 303-314[in Persian].
 
55-Kossovsky MP, Chopard P, Bolla F, Sarasin FP, Louis-Simonet M, Allaz AF, Perneger TV, Gaspoz JM. Evaluation of quality improvement interventions to reduce inappropriate hospital use. International journal for quality in health care. 2002;14(3):227-32.