Background:Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section.Mothers are in...Background:Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section.Mothers are instructed to bring their newborn to a clinic after discharge for a health assessment.We sought to determine the rate of newborn follow-up visits and the potential barriers to timely follow-up.Methods:Mother-newborn dyads at Tygerberg Hospital in Cape Town,South Africa were enrolled from November 2014 to April 2015.Demographic data were obtained via questionnaire and medical records.Mothers were contacted one week after discharge to determine if they had brought their newborns for a follow-up visit,and if not,the barriers to follow-up.Factors associated with follow-up were analyzed using logistic regression.Results:Of 972 newborns,794(82%)were seen at a clinic for a follow-up visit within one week of discharge.Mothers with a higher education level or whose newborns were less than 37 weeks were more likely to follow up.The follow-up rate did not differ based on hospital length of stay.Main reported barriers to follow-up included maternal illness,lack of money for transportation,and mother felt follow-up was unnecessary because newborn was healthy.Conclusions:Nearly 4 in 5 newborns were seen at a clinic within one week after hospital discharge,in keeping with local practice guidelines.Further research on the outcomes of this population and those who fail to follow up is needed to determine the impact of postnatal healthcare policy.展开更多
背景疾病诊断相关组(diagnosis related groups,DRGs)作为一种新的医疗支付方式,不仅综合考虑了疾病复杂性及严重度,还考虑了医疗需要及资源使用强度。目的探讨DRGs数据分析在医院绩效评估中的应用效果。方法导入北京市某三甲综合医院(...背景疾病诊断相关组(diagnosis related groups,DRGs)作为一种新的医疗支付方式,不仅综合考虑了疾病复杂性及严重度,还考虑了医疗需要及资源使用强度。目的探讨DRGs数据分析在医院绩效评估中的应用效果。方法导入北京市某三甲综合医院(以下简称某院)2015年(模拟DRGs付费第1年)出院的医保病例,共计123591例。以住院医疗服务能力和专科能力建设为测算核心,选取DRGs组数、病例组合指数、费用消耗指数、时间消耗指数、低风险和中低风险死亡率为测算指标。选取北京市同等级同类别的三甲医院为标杆医院,标杆医院2015年同时期出院的医保病例10000例为标杆数据。通过对某院各专业与标杆医院相对应专业的比较,了解某院各专业医疗服务现状、资源使用和质量安全情况。结果2015年某院医保患者出院病例123591例,其中入组113402例,未入组10189例,入组率91.7%。某院涉及DRGs组数751组,标杆医院DRGs组数639组;某院病例组合指数(case mix index,CMI)为1.21,标杆医院1.34;某院费用消耗指数1.40,标杆医院1.20;某院时间消耗指数0.98,标杆医院0.84;某院低风险死亡率0.01%,标杆医院0;某院中低风险死亡率0.10%,标杆医院0.09%。与标杆医院比较,某院DRG组数较多,CMI较低,费用消耗和时间消耗指数较高,低风险和中低风险死亡率略高。结论与标杆医院DRGs数据比较,某院疾病诊疗广度较高,医疗技术难度较低,绝大多数病组费用偏高,但平均住院日控制较好,医院可以在基本绩效政策不动摇的前提下,较好地运用DRGs方法进行测算评估,为医院工作提供借鉴和思路。展开更多
基金Support has been provided by Stellenbosch University Rural Medical Education Partnership Initiative(SURMEPI).
文摘Background:Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section.Mothers are instructed to bring their newborn to a clinic after discharge for a health assessment.We sought to determine the rate of newborn follow-up visits and the potential barriers to timely follow-up.Methods:Mother-newborn dyads at Tygerberg Hospital in Cape Town,South Africa were enrolled from November 2014 to April 2015.Demographic data were obtained via questionnaire and medical records.Mothers were contacted one week after discharge to determine if they had brought their newborns for a follow-up visit,and if not,the barriers to follow-up.Factors associated with follow-up were analyzed using logistic regression.Results:Of 972 newborns,794(82%)were seen at a clinic for a follow-up visit within one week of discharge.Mothers with a higher education level or whose newborns were less than 37 weeks were more likely to follow up.The follow-up rate did not differ based on hospital length of stay.Main reported barriers to follow-up included maternal illness,lack of money for transportation,and mother felt follow-up was unnecessary because newborn was healthy.Conclusions:Nearly 4 in 5 newborns were seen at a clinic within one week after hospital discharge,in keeping with local practice guidelines.Further research on the outcomes of this population and those who fail to follow up is needed to determine the impact of postnatal healthcare policy.
文摘背景疾病诊断相关组(diagnosis related groups,DRGs)作为一种新的医疗支付方式,不仅综合考虑了疾病复杂性及严重度,还考虑了医疗需要及资源使用强度。目的探讨DRGs数据分析在医院绩效评估中的应用效果。方法导入北京市某三甲综合医院(以下简称某院)2015年(模拟DRGs付费第1年)出院的医保病例,共计123591例。以住院医疗服务能力和专科能力建设为测算核心,选取DRGs组数、病例组合指数、费用消耗指数、时间消耗指数、低风险和中低风险死亡率为测算指标。选取北京市同等级同类别的三甲医院为标杆医院,标杆医院2015年同时期出院的医保病例10000例为标杆数据。通过对某院各专业与标杆医院相对应专业的比较,了解某院各专业医疗服务现状、资源使用和质量安全情况。结果2015年某院医保患者出院病例123591例,其中入组113402例,未入组10189例,入组率91.7%。某院涉及DRGs组数751组,标杆医院DRGs组数639组;某院病例组合指数(case mix index,CMI)为1.21,标杆医院1.34;某院费用消耗指数1.40,标杆医院1.20;某院时间消耗指数0.98,标杆医院0.84;某院低风险死亡率0.01%,标杆医院0;某院中低风险死亡率0.10%,标杆医院0.09%。与标杆医院比较,某院DRG组数较多,CMI较低,费用消耗和时间消耗指数较高,低风险和中低风险死亡率略高。结论与标杆医院DRGs数据比较,某院疾病诊疗广度较高,医疗技术难度较低,绝大多数病组费用偏高,但平均住院日控制较好,医院可以在基本绩效政策不动摇的前提下,较好地运用DRGs方法进行测算评估,为医院工作提供借鉴和思路。
