基于DRGs的云南某医院COPD患者重复入院影响因素分析

An Analysis of Influencing Factors for COPD Patients Readmission to Hospital in Yunnan Province Based on DRGs

目的分析基于疾病诊断相关分组(DRGs)的云南某医院慢性阻塞性肺疾病(COPD)患者重复入院的影响因素。方法整群抽取2017年1月至2019年12月仅在云南某三甲医院发生再入院的COPD患者以及同时间段内就诊于同一医院并且未发生任何医疗机构再入院的COPD患者进行分析。结果重返组COPD患者平均年龄、居住地为昆明市区、离医院距离0~10 km的比例、平均相对权重RW和平均住院天数均高于非重返组(P <0.01),而非重返组COPD患者农民或无业、使用呼吸机的比例、病程在1 a以下的比例均明显高于重返组(P <0.01);多元线性回归分析结果表明,年龄越大、居住地为市区、病程越长、病情越重和平均住院天数越长的COPD患者重返入院的可能性越大(P <0.01)。结论可利用分级诊疗等措施对于年龄越大、居住于昆明市区、病程较长、根据DRGs数据平台相关反馈患者权重高、有呼吸机治疗、特定DRG分组、住院平均时间长进行分级,难度较高较危重的患者该三甲医院可制定有针对性的治疗措施及临床路径,而对于情况较好的患者可在距离较近的社区医院进行普通治疗,从而降低COPD患者的重复入院次数,合理减轻患者的经济负担,提高患者的生活质量。

Objective The aim of this study is to analyze the factors affecting re-admission to hospitals of the patients with chronic obstructive pulmonary disease(COPD)in Yunnan province based on the diagnosis related groups(DRGs).Methods Clustering sampling method was used to select COPD patients who were re-admitted to a top three hospital in Yunnan province from 2017 to 2019,and random sampling method was used to choose COPD patients who received the treatment in any hospitals during the same period without re-admission.Results The average age of COPD patients in the re-admission group,the proportion of residents living in kunming,the ratio of0-10 km away from the hospital,the average relative weight RW and the average length of hospital stay in the readmission group were all higher than those in the non-readmission group(P<0.01),while returning to the group of COPD patients(farmers or the unemployed),the proportion of patients using ventilator,and the proportion of patients with disease course less than 1 year were significantly higher than those in the re-admission group(P<0.01).Multiple linear regression analysis showed that the older the patient,the urban location of residence,the longer the course of illness,the more severe the illness,and the longer the average length of stay,the greater the likelihood of re-admission for COPD patients(P<0.01).Conclusion To grade the patients,who is older,having longer duration of living in Kunming city,having longer course,with high Relative Weight,having the breath machine treatment,in the specific DRG groups,having longer average hospitalization time by relevant feedback on the DRGs data platform.The top three hospital should develop targeted treatment and clinical pathway to the patients who are in a critical condition.And for patients who are in better status can get medical care in a closer community hospital.In this way,we can reduce the number of COPD patients who are in admitted to hospital repeatedly,reduce the economic burden of patients reasonably,improve the quality of life.