世界银行-加强出院以提高摩尔多瓦患者护理和卫生系统的可持续性（英）.pdf

POLICYNOTE: :HOSPITALDISCHARGEStrengtheningHospitalDischargetoImprovePatientCareandHealthSystemSustainabilityinMoldovaM.Schack,T.B.Muthee,I.Volovei,andY.N.RupasingheAPRIL2024Health,NutritionandPopulationGlobalPracticeSocialProtectionandJobsGlobalPracticePublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorized2: :StrengtheningHospitalDischargetoImprovePatientCareandHealthSystemSustainabilityinMoldovaStrengtheningHospitalDischargetoImprovePatientCareandHealthSystemSustainabilityinMoldovaM.Schack,T.B.Muthee,I.Volovei,andY.N.RupasingheEXECUTIVESUMMARY•InitsNationalDevelopmentStrategy2030,theGovernmentofMoldovamadeaddressingnoncommunicablediseases(NCDs)akeypriority.AspartoftheefforttolessentheburdenofNCDs,theMinistryofHealth(MoH)launchedseveralambitiousinitiativesfocusedonoptimizingthenationalhospitalnetwork,regionalizingstrokecare,andmodernizingrehabilitationservices.•Thehospitaldischargeprocessisacriticalstepinensuringthatapatient’sneedsarefullymetinordertoachievethebestpossiblehealthoutcomesafteranacuteepisode.Thisstepisespeciallyimportant-andchallenging-forpatientswhohavemorecomplexneedssuchasthoseassociatedwithchronicdiseases,orwhoneedadditionalpost-dischargecaresuchasrehabilitationservices.•Infragmentedhealthsystems,suchasMoldova’s,suboptimaldischargeprocessescansignificantlyimpacttreatmentadherence,continuityofcareandhealthoutcomes,increasingtheriskofrehospitalizationandadverseevents(whichstudieshavefoundcanaffect19%to23%ofpatientswithinthreeweeksofdischarge).•KeyareasforimprovementidentifiedwithregardstothehospitaldischargeprocessinMoldovaincludeinsufficientinformationsharingandcoordinationbetweenhospitals,primaryhealthcareandsocialcare;alackofincentivesforhospitalstoimprovecontinuityofcare;andlimitedinfrastructureforpost-dischargecare,especiallywithregardstorehabilitationservicesandhomecare,whichcreatesdelaysorgapsincarethatcanaffectapatient’srecovery.•Theneedforamoreholisticlensandgreaterstandardizationofthedischargeprocessatthenationallevelwasraised,andrecommendationsincludethedevelopmentofstandardizedassessmenttoolsandguidelinestosupportamoresystematicandperson-centeredapproach.•Digitizationisanotherimportantelementofstrengtheningthehospitaldischargeprocess,andtheimplementationofseveraldigitalhealthinitiatives(suchase-referralsande-appointmentsystems)isalreadyakeypriorityfortheMoH,aimedatimprovinginformationsharingandcoordinationbetweenthedifferentlevelsofthehealthsystem.•Inaddition,expandingworkforceskillsanddevelopingperformanceindicatorsandpaymentmechanismswereidentifiedaskeyleverstopromoteandincentivizegreatercontinuityandcoordinationofcareinthiscontext.•Finally,patientsandcaregiversmustplayacentralroleinanystrategyaimingtosupportsafeandeffectivetransitionsofcare,andstrengtheningpatienteducationandsupportforinformalcarerswashighlightedasakeyareaoffocus.•Strengtheningthehospitaldischargeprocesswouldresultinamoreefficienthealthsystem,betterequippedtoaddresstheriseincomplexdischargeneedsfuel