剖宫产药占比的影响因素及中断时间序列分析

Influence Factors and Interrupted Time Series Analysis of Drug Proportion of Cesarean Delivery

目的分析广州市某三甲医院剖宫产产妇出院药占比,探讨其影响因素及医药卫生体制改革政策对药占比的干预效果。方法选择某三甲医院2005年-2015年剖宫产产妇病案首页数据,进行Logistic回归分析和中断时间序列分析。结果药占比的影响因素有合并手术(OR=0.49,95%CI=0.43~0.57)、妊娠伴随疾病(OR=1.53,95%CI=1.38~1.70)、入院时病情(OR=1.31,95%CI=1.15~1.50)、患者来源(OR=1.28,95%CI=1.17~1.41)、有无保险(OR=2.01,95%CI=1.76~2.30)、住院天数(OR=1.38,95%CI=1.25-1.53)和出院年份(OR=2.10,95%CI=1.90~2.33)。医药卫生体制改革对药占比的影响显著,导致药占比绝对下降了22.02%。结论医药卫生体制改革显著降低了剖宫产产妇的出院药占比;此外缩短住院天数、提高医保纳入比例等也能在一定程度上降低剖宫产的药占比。

Objectives To analyze the drug proportion of cesarean delivery in a tertiary hospital in Guangzhou,in order to discuss the influence factors and intervention effect of the medical and health system reform. Methods Logistic regression analysis and interrupted time series analysis were used to analyze the medical record data of cesarean delivery women coming from a tertiary hospital during 2005 and 2015. Results The influence factors of drug proportion were combined operation（OR=0.49,95% CI=0.43-0.57）,pregnancies accompany disease（OR=1.53,95% CI=1.38-1.70）,state of illness when hospitalized（OR=1.31,95% CI=1.15-1.50）,current address（1.28,95% CI=1.17-1.41）,insurance（OR=2.01,95% CI=1.76-2.30）,days in hospital（OR=1.38,95% CI=1.25-1.53） and the year discharged from hospital（OR=2.10,95% CI=1.90-2.33）.The influence of the medical and health system reform on drug proportion was significant,accounted for absolute dropped by 22.02%.Conclusions Drug proportion of cesarean delivery was significantly reduced by the medical and health system reform.In addition,shorten the hospital stay and improve the proportion of health insurance could also to a certain extent reduce drug proportion of cesarean delivery.