Primary health care replacing hospital care--the effect on quality of care.
In order to change current practice concerning hospital stays, a project was initiated in which shortening hospital stay was combined with shifting care to primary health care. Research was aimed at assessing quality of care of shortened hospital stays with home care by the community nurse and/or the general practitioner (GP). A randomized clinical trial was conducted with three subgroups: 1. traditional hospital stay; 2. hospital admission on the day of surgery, discharge the day after; two consultations at the outpatient department; one visit by the community nurse before surgery, two visits after; 3. mostly as for 2. with two GP visits replacing the two consultations at the outpatient department. The selected surgical procedures were: laparoscopic cholecystectomy, varicose veins, removal of osteosynthesis material, hernia surgery and other minor surgery (normal hospital stay 4-6 days). Every motivated patient meeting the inclusion criteria entered the study. During one year 120 patients were thus selected. Only minor differences were found between the three subgroups in the resulting quality of care. It is concluded that late admission and early discharge even without after discharge care is feasible in most cases for healthy patients.
Kaag
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ME
Research Center Primary/Secondary Health Care, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. mec.kaag@azvu.nl
Wijkel
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de Jong
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D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007902:Length of Stay; D009426:Netherlands; D010351:Patient Discharge / Q000592:standards; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000639:trends*