上海市恶性肿瘤死亡患者临终期住院行为分析

Analysis of Hospitalization Behavior of Dying Patients with Malignant Tumor in Terminal Stage in Shanghai

目的:分析恶性肿瘤患者临终期诊疗行为,总结其特点及发现存在的可能问题,为调整、优化资源配置提供循证依据,从而更好地满足患者需求。方法:收集2016年上海市住院期间因恶性肿瘤死亡居民的临终期住院记录,分析其临终前住院服务量、机构构成、转院情况以及机构流向等特点,采用Gephi绘制可视化图直观反映转院情况和区域分布情况。结果:临终期内住院次数和住院服务需求的增长趋势近似"指数"形式,尤其是临终前最后一季度。住院主要集中在三级医院,但比非临终期患者较临终期患者的三级医院住院的构成比低。分析患者的住院机构选择,约一半患者固定在1家机构住院,90%的患者住院机构数量在3家以内。转诊具有明显的区域性,郊区患者在区域内就诊比较明显,市区患者主要集中在市区三级医院。结论:根据恶性肿瘤患者临终期住院服务特点,建议从资源配置与服务利用两方面进行优化。在资源配置上,加强区域医疗中心和基层建设,缓解三级医院住院服务压力,方便患者就诊。在服务利用方面,加强上下转诊标准建设,合理引导患者分流;对医疗机构管理及考核根据临终期的特点来调整标准。

Objective: To analyze the hospitalization behavior of dying patients with malignant tumor, it summarized their characteristics and found possible problems, and provided evidence-based basis for adjusting and optimizing the allocation of resources, so as to better meet the demand of patients. Methods: The hospitalization records of Shanghai residents who died of malignant tumors in Shanghai in 2016 were collected and the characteristics of hospitalization behavior before death were analyzed, such as hospitalization service, institutional composition, hospital transfer and institutional flow direction. Meanwhile, Gephi was applied to draw visual maps to reflect the situation and distribution of hospitals. Results: The growth trend of hospitalization times and hospitalization service demand of dying patients with malignant tumor were similar to "index” pattern, especially in the last quarter before death. Malignant tumor patients mainly concentrated in tertiary hospitals, but the proportion in tertiary hospitals was lower than non-terminal patients. From the point of hospital transfer, about half of the patients stayed in the same hospitals, 90% of the patients were hospitalized in less than 3 hospitals. Referral had obvious regional, suburban patients were mainly treated in the region, urban patients were mainly concentrated in tertiary hospitals. Conclusion: According to the characteristics of hospitalization services of dying patients with malignant tumor, it was suggested to optimize the allocation of resources and utilization of services. In terms of resource allocation, regional medical centers and grass-roots construction should be strengthened to alleviate the pressure of hospitalization service in tertiary hospitals and facilitate patients5 treatment. In terms of service utilization, it should strengthen the construction of refenal standards, reasonably guide patients to diversify and adjust the standards of the management and assessment according to the characteristics of the terminal stage.