全国三级公立医院卒中医疗质量现状分析

Medical Quality of Stroke in Tertiary Public Hospitals in China:Analysis of Hospital Quality Monitoring System

目的描述全国三级公立医院卒中住院患者医疗质量现状。方法采用病案首页主要诊断和其他诊断的疾病编码,提取医院质量监测系统中2013年1月1日至2018年12月31日脑梗死(I63)和脑出血(I61)两种类型卒中住院患者信息。并描述卒中患者人口学信息、住院费用及其付费方式、危险因素诊断及出院时情况。结果全国506家三级公立医院共计8426489例卒中患者中,脑梗死、脑出血和蛛网膜下腔出血患者分别为7558404和868085例,男性患者居多,中位年龄分别为69.0(60.0~77.0)和61.0(51.0~70.0)岁。卒中患者付费方式以社会基本医疗保险为主,全自费方式的比例呈逐渐下降趋势(从14.1%降至9.7%)。卒中危险因素较高的疾病为高血压病(61.6%~67.7%)、糖尿病(11.1%~25.3%)、冠心病/心肌梗死(6.9%~24.1%)、血脂异常(5.3%~13.6%)、心律失常(4.9%~11.9%)、心衰(2.8%~10.0%)和心房颤动(2.3%~5.3%)。卒中患者住院死亡率呈逐年下降趋势(从1.9%降至1.2%)、非医嘱离院444419例(5.3%)。结论基于病案首页信息可以描述我国的卒中医疗质量信息,为我国卒中持续质量改进提供宝贵数据。

Objective To describe the status of medical quality of inpatients with stroke in tertiary public hospitals in China.Methods The disease codes of main diagnosis and other diagnosis of front page of medical records were adopted.From January 1st,2013 to December 31st,2018,the hospital quality monitoring system(HQMS)data of inpatients with cerebral infarction(I63)and cerebral hemorrhage(I61)were extracted,including the information of diagnosis,demographic characteristics,expenses,methods of payment,cerebrovascular disease risk factors and discharge status.Results Among a total of 8426489 stroke patients in 506 hospitals in China,there were 7558404 cerebral infarction patients and 868085 cerebral hemorrhage patients;mostly male patients.The median ages of stroke patients were 69.0(60.0-77.0)and 61.0(51.0-70.0)years old,respectively.The payment mothed of stroke patients were mainly national basic medical insurance.The proportion of full self-payment was on the decline trend(14.1%~9.7%).High risk factors of stroke included hypertension(61.6%~67.7%),diabetes mellitus(11.1%~25.3%),coronary heart disease or myocardial infarction(6.9%~24.1%),dyslipidemia(5.3%~13.6%),arrhythmia(4.9%~11.9%),heart failure(2.8%~10.0%)and atrial fibrillation(2.3%~5.3%).The in-hospital mortality of stroke patients showed a trend of the decrease year by year(1.9%to 1.2%),and 444419 patients(5.3%)discharged against medical advice.Conclusion Based on the information on the front page of the medical records,we can describe the stroke medical quality information in China,and provide valuable data for the continuous improvement of stroke quality in China.