三级综合医院住院日≥30天患者分布特征及影响因素分析

Analysis on distribution characteristics and risk factors of extended stay at tertiary comprehensive hospitals

目的分析住院日≥30天患者的分布特征及影响因素，探索缩短医院平均住院日的方法。方法收集山西省31家三级综合医院2014年10月至2015年10月所有出院患者的病历首页，筛选出住院日≥30天且病例信息完整的患者共39 234例。应用广义线性模型对此部分患者住院日的影响因素进行统计分析。结果39 234例患者住院日主要集中在30～40天，占全部患者数量的50.21%，且日均费用最高。随着住院日延长，患者比例逐渐减小，整体呈极偏态分布。住院日≥30天的患者数量分布显示，城镇职工医保在所有费别中占比最高，骨科在所有出院科室中占比最高，损伤和中毒类疾病在所有疾病分类中占比最高。性别、费别、ICD疾病分类、转科、院内感染、临床路径等10种因素对患者住院时间延长有显著影响。结论加强重点科室及疾病的患者管理、把握质控关键环节、推进医保付费方式改革是控制住院时间延长的有效途径。

Objective To analyze the distribution characteristics and risk factors of extended stay over 30 days at tertiary comprehensive hospitals, and explore methods of shortening average length of stay（LOS）.Methods Homepage of all inpatients discharged from October 2014 to October 2015 of 31 tertiary comprehensive hospitals in Shanxi province were collected. 39 234 cases of these inpatients stayed over 30 days and their case information was complete. A generalized linear model was used for risk factors analysis.Results With the extension of LOS, most of the inpatients with extended stay were found during their 30th-40th days, accounting for 50.21% of all and constituting the highest daily costs as well. The ratio of inpatients decreases with their LOS, and its distribution presents a positive skew in entirety. Distribution of inpatients over 30 days identified urban employees under medical insurance accounting for the highest ratio among all payment categories, and those from the department of orthopedics for the highest ratio among all departments, while those of diseases from injury and poisoning accounting for the highest ratio among all disease categories. The findings indicated ten important factors for extended stay, namely gender, medical payment category, ICD, inter-department transfer, nosocomial infection, and clinical pathway.Conclusions To strengthen management of specific departments and inpatients, focus on key process of medical quality, and accelerate medical insurance payment reform can effectively control extended stay.