患者非医嘱离院现状及相关特征分析

Analysis of 2496 Patients Discharged from Hospital without Doctor's Advice

目的 了解患者非医嘱离院现状及相关特征。方法 利用某院2015年出院患者数据,应用卡方检验和秩和检验分析非医嘱离院与医嘱离院成年患者的特征区别,应用多因素logistic回归分析比较不同患者特点与非医嘱离院的因果关系。结果 某院2015年成年患者出院42 682人次,非医嘱离院率为5.8%。非医嘱离院患者年龄中位数为56（35-71）岁,较医嘱离院患者年龄大（P〈0.001）;中位住院天数为5（3-10）天,中位住院费用为0.65（0.37-1.34）万元,均较医嘱离院患者少（P〈0.001）。男性（OR=1.58,95%CI1.43-1.75）、急诊入院（OR=1.25,95%CI 1.14-1.37）、全自费（OR=1.55,95%CI 1.41-1.70）、有抢救（OR=3.37,95%CI 2.80-4.07）是非医嘱离院的危险因素,而中年（31-50岁）（OR=0.74,95%CI 0.64-0.85）、入院病情明确（OR=0.75,95%CI 0.68-0.82）、有手术操作（OR=0.57,95%CI 0.51-0.63）、多次在该院住院（OR=0.78,95%CI 0.71-0.86）是非医嘱离院的保护因素。不同科室的非医嘱离院危险性不同（P〈0.001）。结论 成年医嘱离院与非医嘱离院患者就诊特征存在差别,可采取针对性措施降低非医嘱离院率,利于患者的身体健康和提高医院的社会效益和经济效益。

Objective To investigate the status of patients discharged from hospital without doctor＇ s advice and analyze the related factors. Methods Data from in-patient medical record front sheet of adult patients in 2015 was analyzed. Using chi square test and rank sum test to find the differences between patients discharged from hospital with and without doctor＇s advice and the risk factors were determined by multivariate logistic regression analysis. Results 2496 of 42682 adult patients were discharged without doctor＇s advice, equivalently 5.8% of all the adult discharged patients. The patients discharged without doctor＇s advice were older （56 （35-71） years, P〈0. 001）, stayed shorter （5 （3-10） days, P〈0. 001）, with less hospitalization expenses （6. 5 （3.7-13.4） thousand, P〈 0. 001）. Male（OR=l. 58, 95%CI 1.43-1.75）, admission from emergency department （OR=1. 25, 95%CI 1.14- 1.37）, with first aid treatment （OR=3.37, 95%CI 2. 80-4. 07） and without medical insurance （OR=I. 55, 95%CI 1.41-1.70） were the risk factors for discharging without doctor＇s advice, while middle age （31-50y） （OR=0. 74, 95%CI 0. 64-0. 85）, with definite diagnosis in admission （OR=0. 75, 95%CI 0.68-0. 82）, with operative procedure （OR=0. 57, 95%CI 0. 51-0. 63） and multiple hospitalization （OR=0. 78, 95%CI 0. 71-0. 86） were the protective factors. Conclusions There were differences between patients discharged with and without doctor＇ s advice.