无效住院在住院服务提供过程中的存在现状

Existence of unnecessary hospitalization in in-patient service provision

目的研究无效住院在住院服务提供过程中的存在现状,包括入院和住院日的无效率、无效住院日在入院诊疗期间以及在人群中的分布。方法选择上海交通大学医学院附属仁济医院妇科和神经内科作为样本单位。根据2011年的入院人数,妇科抽取185例/月,神经内科抽取100例/月。在2011年12月及2012年3月和6月入院患者中进行随机抽样。由2名临床护士根据入院及住院日适宜性评估标准(AEP)对样本病例的入院及住院日适宜性进行判定。对病例的入院和住院日无效率进行统计学描述,分析不同入院适宜性条件下的住院日无效率,采用洛伦兹曲线、基尼系数描述无效住院日在人群中的分布状况。结果共调查855例,入院无效率为14.62%,住院日无效率为24.88%。无效入院患者的住院日无效率高于有效入院患者,差异具有统计学意义(P<0.01)。随着整个诊疗过程的推进,住院日无效率逐步增加;洛伦兹曲线表明无效住院日在研究对象中分布的均匀性较差。结论无效入院的患者,其入院诊疗期间的无效住院日更多;无效住院日集中于少数患者的入院诊疗中;住院天数较短并不意味入院诊疗过程中的无效住院日较少。

Objective To investigate the existence of unnecessary hospitalization in in-patient service provision, including the proportion of unnecessary admission and unnecessary in-patient days, as well as the distribution of unnecessary in-patient days in the hospitalized stays and in the sample patients. Methods Department of Gynecology and Department of Neurology of Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine were selected as sample. Based on the admissions in 2011, 185 medical records per month were selected from Department of Gynecology, and 100 medical records per month were selected from Department of Neurology. All sample records were selected from patients with admission in December 2011, March 2012 and June 2012. Two nurses conducted the retrospective review of selected records and made the judgments based on the Appropriateness Evaluation Protocol （AEP） criteria. The statistical description of the proportion of unnecessary admission and unnecessary in-patient days was conducted, difference analysis of the proportion of unnecessary days between necessary admission and unnecessary admission was made, and Lorenz curve and Gini coefficient were used to illustrate the distribution of unnecessary days in the sample. Results There were 855 medical records in the sample. The proportion of unnecessary admissions was 14.62%, and that of unnecessary in-patient days was 24.88%. Unnecessary admissions caused more unnecessary days than did necessary admissions, and such differences were statistically significant （P 〈 0.01）. Among the successive hospitalized days since admission, the proportion of unnecessary days was gradually higher. Lorenz curve demonstrated that unnecessary days were unevenly distributed among sample patients. Conclusion Unnecessary admissions cause more unnecessary days. Unnecessary days are concentrated among a minority of patients. Short stays do not generate significantly fewer unnecessary days than do longer stays.