我国二三级医院住院患者死亡率影响因素

Influencing Factors of Mortality within Secondary and Tertiary Hospitals in China

目的分析我国二三级医院住院患者死亡率的差异及其影响因素。方法选取《中国二三级医院医疗服务能力》基线调查中的422家二级医院和151家三级医院的数据进行分析。结果我国二级医院的住院患者死亡率与三级医院的住院患者死亡率的差异具有统计学意义(OR 0.354,95%CI 0.219~0.571,P<0.001);不同区域、地区和类型的二三级医院的住院患者死亡率的差异均有统计学意义;护士人均住院患者与住院患者死亡率负相关(OR 0.977,95%CI 0.966~0.987,P<0.001);平均住院日与住院患者死亡率正相关(OR 1.167,95%CI 1.061~1.283,P<0.001);未发现医师和护士的学历与住院患者死亡率有关。结论总体上,二三级医院间的住院患者死亡率的差异具有统计学意义,并且每个区域、地区和类型内的二三级医院住院患者死亡率差异也具有统计学意义,这可能是由病情轻重程度和医疗水平的差异所致。

Objective To analyze the differences and influencing factors of inpatient mortality between secondary and tertiary hospitals in China. Methods We analyzed the data of 422 secondary hospitals and 151 tertiary hospitals from the baseline survey of Healthcare Service Capacity for Chinese Secondary and Tertiary Hospitals. Results The difference of inpatient mortality between secondary hospitals and tertiary hospitals in China had statistical significance（ OR 0. 354,95% CI 0. 219 ~ 0. 571,P 0. 001）. There was statistical significance for the difference of mortality between secondary and tertiary hospitals within all regions,districts and types. Patients per nurse had a negative correlation with inpatient mortality（ OR 0. 977,95% CI 0. 966 ~ 0. 987,P 0. 001）. Average length of stay had a positive correlation with inpatient mortality（ OR 1. 167,95% CI 1. 061 ~ 1. 283,P 0. 001）. There was no correlation found between inpatient mortality and education background of doctors and nurses. Conclusion The difference of inpatient mortality between secondary and tertiary Hospitals has statistical significance in general,as well as within each of the regions,districts and types,which probably due to the difference of patients＇ disease severity and hospitals＇ medical level.