Is discharge policy a balanced decision between clinical considerations and hospital ownership policy? The CABG example
| Autor: | Yana Zitser-Gurevich, Noya Galai, Avi Israeli, Elisheva Simchen |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Pediatrics Cost-Benefit Analysis Population Affect (psychology) Patient Readmission Coronary artery bypass surgery Postoperative Complications Insurance carriers Hospital Administration medicine Humans Coronary Artery Bypass education Survival analysis Health policy education.field_of_study business.industry Public health Ownership Length of Stay Middle Aged Patient Discharge United States Increased risk Emergency medicine Surgery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 126(4) |
| ISSN: | 0022-5223 |
| Popis: | Objectives To explore to what extent patient discharge from the hospital is a balanced decision between clinical considerations and management policy; specifically: (1) to assess the role of patient risk as a determinant of discharge in comparison with administrative factors such as hospital ownership; (2) to evaluate whether variations in discharge policy were translated into differences in clinical outcomes. Methods A national study of coronary artery bypass surgery was used as an example. The population included 4778 patients undergoing coronary artery bypass surgery in 14 institutions. The mode of discharge day, rather than the mean, was used as the best indicator of discharge policy. Parametric survival model was used to assess factors associated with the day of discharge. Results The mode of discharge day varied widely among institutions. This variation between 4 and 7 days after surgery corresponded to hospital ownership. The mode of discharge day was almost invariant to the patients' risk, but serious postoperative complications resulted in prolonged stay for a minority of the patients. The influence of hospital ownership prevailed over patient insurance carriers. Differences in discharge policies were not associated with increased risk of late mortality or rehospitalization. Conclusions Discharge policy beyond the rare occurrence of dramatic patient postoperative complications was mainly dependent on hospital owner's cost-effectiveness considerations. However, despite the weight given to administrative factors in the decision-making process, it did not affect the outcome of care. |
| Databáze: | OpenAIRE |
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