2001-2011年我国东部城市地区急性心肌梗死患者住院时长分析

Length of stay for acute myocardial infarction patients in eastern urban area of China during 2001-2011

目的 我国急性心肌梗死（AMI）的疾病和经济负担日益严峻,而医疗资源总量有限且分布不均.住院时长则是衡量医疗资源利用的一项重要指标.本研究旨在描述我国东部城市地区AMI患者平均住院时长的情况和变化趋势,同时探索影响住院时长有关的医院特征.方法 本研究通过随机抽样收集我国东部城市地区13省份32家医院2001、2006、2011三个年份的代表性急性AMI住院患者病历资料,描述住院时长及其变化趋势,并按照住院时间的中位数将医院划分为三类,进而比较它们之间在患者特征、院内诊疗和结局方面的差异.结果 本研究共纳入5 047例急性AMI住院病历.2001、2006及2011年的平均住院时长分别为（15.3±10.2）、（13.5±8.7）、（12.2±7.8） d,呈逐年缩短趋势（F=10.93,〈0.001）,而在调整患者因素差异之后,各年份间住院时长的差异无统计学意义.在平均住院时长高中低的三类医院之间,收治患者的临床特征差异并不突出,但平均住院时长越长的医院中,急性期阿司匹林、氯吡格雷和住院期间他汀的使用率越低（P≤0.001）.而AMI治疗规模较小的医院,住院时长更长.而相比于年AMI住院患者超过80例的医院,年AMI住院患者30-80例的医院中平均住院时长多1.9 d（t=2.97,〈0.01）.结论 我国东部城市地区医院急性AMI的平均住院时长与欧美水平相比仍有较大差距,而医院间比较也凸显了相关医疗服务质量和资源利用效率方面的不足.在深化医改的进程中大力推行规范化临床路径和分级诊疗,对于应对不断加剧的心血管疾病负担具有重要意义.

Objective China is experiencing increasing disease burden and economic burden of acute myocardial infarction（AMI）,while the healthcare resources are limited and unevenly distributed.Hospitalization duration is an important measure of health resource utilization index.This study aims to describe the time trend of Length of stay（LOS） for AMI inpatient care in eastern urban areas of China,and to identify potential hospital-level factors associated with the LOS,which is an important indicator of resource utilization.Methods The study randomly selected a representative sample of patients admitted for AMI in 2001,2006 and 2011,from urban hospitals in eastern China.After central data abstraction from medical records,patients＇ characteristics,treatments and outcomes were compared between 3 hospital groups that were divided according to their median of LOS.Results Five thousand and forty-seven AMI cases were included in the analyses.The average LOS were （15.3±10.2）,（13.5±8.7） and （12.2±7.8） d in 2001,2006 and 2011 respectively,with a decreasing trend（F=10.93,〈0.001）.After adjusted for patients＇ characteristics,there were no significant different in LOS between years.Patients＇ characteristics were similar between high-,middle-and low-LOS hospitals,however,in high-LOS hospitals,use rates of aspirin,clopidogrel and statins were even lower（P≤0.001）.LOS were longer 1.9 d in the hospitals with relatively small AMI inpatient treatment volumes（30-80 annually,t=2.97,〈0.01）.Conclusions The average LOS for AMI in eastern urban areas of China is much longer than in western countries.Conclusion between hospitals have highlighted the gaps in care quality and efficiency.Standardized clinical pathways and hierarchical medical system are essential strategies in the new healthcare reform.