基于间断时间序列模型的院前检查对平均住院日影响的研究

Study on the influence of pre-hospital examination on average hospitalization days based on interrupted time series model

目的评价医院实施院前检查对患者平均住院日的影响。方法分别选择耳鼻喉科(腺样体肥大、中耳炎)和血液科最常见的2种疾病(白血病、淋巴瘤),从医院电子病历数据库中提取实施院前检查前后各6年共144个月的患者数据,采用间断时间序列模型分析院前检查实施前后患者平均住院日的变化趋势。结果院前检查实施后腺样体肥大、中耳炎和淋巴瘤3种疾病平均住院日分别下降了1.7 d、2.8 d、2.6 d(P<0.05),白血病下降了0.2 d(P>0.05)。分别对年龄、性别及入院病情因素进行校正,院前检查实施1个月腺样体肥大、中耳炎平均住院日斜率较实施前明显下降(P<0.05),淋巴瘤斜率虽下降但无统计学意义(P=0.29),白血病住院日斜率不降反升;持续实施院前检查72个月,除白血病外,腺样体肥大、中耳炎、淋巴瘤患者住院日斜率较刚实施后虽略微上升,但均较实施前明显降低。结论无论从短期效应还是长期趋势来看,院前检查的实施对治疗效果较好疾病(腺样体肥大、中耳炎、淋巴瘤)的平均住院日有明显降低效果,但对住院时间较长、治疗效果不佳(白血病)疾病影响不明显。

Objective To evaluate the effect of pre-hospital examination on average hospitalization days.Methods The two most common diseases in otorhinolaryngology(adenoid hypertrophy,otitis media)and hematology(leukemia,lymphoma)were selected respectively,and the patient data of 144 months before and after 6 years of pre-hospital examination were extracted from the hospital electronic medical record database.The interrupted time-series method was used to analyze the change trend of the average hospitalization days before and after the pre-hospital examination application.Results After the application of pre-hospital examination,the average hospitalization days of adenoid hypertrophy,otitis media and lymphoma decreased by 1.7 days,2.8 days and 2.6 days(P<0.05)respectively,whereas Leukemia decreased by 0.2 days(P>0.05).Adjusted by age,gender and admission condition,the slope of average hospitalization days declined significantly(P<0.05)for adenoid hypertrophy and otitis media,insignificantly(P=0.29)for lymphoma,and did not decrease but increased for leukemia after pre-hospital examination implemented for 1 month.Seventy-two months after the implementation of the examination,except for leukemia,the change slope of adenoid hypertrophy,otitis media,and lymphoma were all slightly higher than right after the implementation,but remained at an obvious lower level than before the implementation.Conclusion No matter for the short-term or long-term trend,pre-hospital examination application has a significant reduction in the average hospitalization days for diseases with better treatment effects(adenoid hypertrophy,otitis media,lymphoma),and has almost no reduction for the disease(leukemia)with longer hospitalization days and poor treatment effects.