上海市单中心儿科门诊特征和医疗服务2009至2018年趋势分析

An analysis of characteristics and trends of outpatient visits and medical services in a tertiary pediatric hospital in Shanghai from 2009 to 2018

目的:探索医院信息系统(HIS)医疗大数据处理方法,分析儿童专科医院近10年门诊患儿就诊特征及医疗服务趋势。方法:以复旦大学附属儿科医院(我院)HIS门诊患儿就诊挂号登记表的全样本数据为基础,系统地进行数据清洗(诊断、地址、重复、离群、缺失)、数据集成(数据库链接和匹配)、数据规约、数据脱敏和数据核查,行门诊患儿就诊特征及医疗服务趋势的分析。结果:2009至2018年我院门诊挂号20 775 899人次,依据纳入和剔除标准,18 242 822人次进入本文分析;男性占57.42%,婴儿占9.57%,幼儿占40.94%,学龄前儿童占24.82%,学龄儿童占24.67%。诊断缺失率为5.92%,地址缺失率为45.31%,接诊医生姓名缺失率为26.81%,行缺失数据人群分析,各年份性别和年龄构成比差别不大。10年间门诊量年平均增长5.22%,2012较2011年增长11.22%,2014较2013年增长10.93%,2015年后环比增长均<2.90%。10年间不同年份各省市门诊量>P 75和~P 50的省市,从华东向西南、西北、华南、中部、东北扩大。10年间门诊医生平均日接诊51人次,初、中和高级职称医生门诊日均接诊分别63、54和45人次;专科门诊从2009年的46个发展为2018年的180个,2018年专科就诊比例达68.12%,专病门诊从2009年的16个发展为2018年的142个。结论:基于国家儿童医学中心之一的我院的门诊数据表明,10年间门诊量先快速增长后平稳增长,患儿来源地区快速从华东地区辐射至全国,门诊医生平均日接诊数量低于全国平均水平,专科门诊和专病门诊成为重要的发展趋势。

Objective :To explore the processing methods of big data of hospital information systems(HIS) and analyze the characteristics and trends of outpatient visits and medical services in a tertiary pediatric hospital in Shanghai during the past 10 years. Methods :Data were extracted from the database of outpatient registry in HIS from 2009 to 2018. Data cleaning (diagnosis, address, replication, outliers, and missing data), data assembly (linkage of database), data reduction, data anonymization and data audit were conducted according to the procedure of big data. We analyzed the characteristics and trends of outpatient visits and medical services. Results :The total outpatient visits from 2009 to 2018 were 20,775,899 and 18,242,822 visits were included in this study. Males were 4,656,843 accounting for 57.42%. Patients under 1 year old, from 1 to 3 years old, from 3 to 7 years old and from 7 to 18 years accounted for 9.57%,40.94%, 24.82% and 24.67% respectively. The missing data rate of diagnosis, address, and name of doctors was 5.92%, 45.31% and 28.61%,respectively. There were no significant differences in the percentage of sex and age in different years among the population with missing data. The average increasing rate of outpatient visits was 5.22% in the past 10 years. The increasing rate of 2012 and 2014 were 11.22% and 10.93% respectively, compared with the same period of last year. The increasing rate slowed down to 2.90% after 2015. The distribution of outpatient address showed the trends of expansion from the east of China to the South-west, North-west, South, Middle and North-east. The average workload of a doctor was 51 visits in a day. According to professional titles, there were 63, 54, and 45 visits per day for junior, intermediate, and senior doctors, respectively. The number of specialty clinics increased from 46 in 2009 to 180 in 2018 and serviced the 68.12% of outpatient visits. The number of specific disease clinics increased from 16 in 2009 to 142 in 2018. Conclusion :The big data of outpatient visits in a tertiary pediatric hospital(National Children's Medical Center) in China showed that there was a sustainable upward trend in outpatient visits;the origin of patients expanded from Shanghai to the whole of China;the average visits for a single physician were lower than that of the country. Specialized clinics in specialties or diseases are an important trends for the development of children's hospitals.