我国慢性非传染性疾病不合理住院现状研究

Analysis of Unreasonable Admission of Non-communicable Chronic Diseases in China

目的：研究可避免入院的评价标准，分析造成不合理入院的原因并提供建议。方法：利用不同省、市、地区，医疗机构级别的住院病历，选取高血压、慢性阻塞性肺炎、充血性心力衰竭三个常见慢性病的ICD—10疾病编码进行分析。由于数据限制，经咨询临床专家，得到了一种可避免入院的评价标准用以代替OECD中定义的入院标准。以住院天数较短，费用较少为原则确定可避免入院病例。结果：三种常见病种的可避免入院病例占总样本量的16％。单因素分析发现三种疾病发生可避免入院的风险因素有地区、医疗机构级别、年龄，差异均有统计学意义（均为P〈0．05）。多因素分析发现二级医疗机构、东部地区、年龄在25～34岁人群是疾病发生可避免入院的危险因素（均为P〈0．05），差异均有统计学意义（P〈0．05）。结论：研究建议制定重点病种入院标准，加强基层医疗设施建设，提高医保审核管理及卫生服务监管力度，保证使用DRG等不同支付方式时卫生费用的合理性。

Objective： To evaluate the evaluation criteria for avoidable admission, analyze the reason for unreasonable admission and provide suggestions. Methods： According to the hospital admissions data at the province, city and county level medical institulions, the ICD-10 codes fi）r hypertension, chronic obstructive pulmonary disease（COPD） and congestive heart failure（CHF） were selected and analyzed. Due to data limitations, the substitutional criteria for avoidable admissions was developed with consulting Chinese clinic.ians. The eases with shorter length of stay and lower expenditure were identified as avoidable admissions. Results： For the three non-communicable chronic diseases, the avoidable admission rate was about 16% of the sample. Univariate analysis showed that region, hospital level and age were related factors. The results were all statistically significant（P〈0.05）. Then the muhivariate analysis showed that the secondary hospital, east region and aged between 25-34 were the independent risk factors（P〈0.05）. Conclusion： The research results suggested to establish the admission criteria for key diseases, reinforce the primary care facility development and enhance health insuram：e audit and health care service supervision so as to ensure the health expenditure rationality during utilizing the DRG and other payment methods.