基于超长住院日患者影响因素的医院优质医疗资源扩容探索

Expansion of Hospital Quality Medical Resources based on the Influencing Factors of Patients with Ultra-Long Stay in Hospital

目的通过对山西省某三甲综合医院2020年度超长住院日患者的分布特征及影响因素分析,探讨超长住院日患者管理的策略,为优质医疗资源扩容提供思路和办法。方法从医院信息系统中调取2020年出院患者的病案资料,以超过30天住院日的1881例患者为研究组,以出院科室为匹配条件,经SPSS病例对照匹配确定未超过30天住院日的1881例患者为对照组。比较分析两组的一般特征、临床特征和费用特征,采用Logistic回归分析超长住院日患者的影响因素。结果超长住院日患者30—39天住院日最多,男女性别比1.17∶1;以体力劳动者(44.02%)、已婚(83.47%)、省内异地(62.95%)、居民医保(33.33%)、门诊入院(75.06%)、未转科(63.10%)、伴其他疾病(97.56%)、肿瘤患者(55.80%)等为主。体力劳动者、全公费/全自费、离异丧偶/未婚、急诊入院、转科、伴有其他疾病、手术、一级手术、病理检查等占比以及次均费用均高于对照组(P<0.05)。Logistic分析结果显示,全公费、全自费、商业医疗保险、未婚、体力劳动者、省外居住、伴有其他疾病、转科、肿瘤患者是超长住院日的危险因素。结论超长住院日受多因素影响,其改善也需要多部门推进。超长住院日是医院效率低下的表现,暴露了医疗质量安全的不足,影响医院优质医疗资源“内源性”扩容,需要以高危因素为切入点,把好关口,降低住院日,扩容优质医疗资源。

Objective By analyzing the distribution characteristics and influencing factors of patients with ultra-long stay in a tertiary general hospital in Shanxi province in 2020,to explore the strategies for patients with ultra-long stay in hospital,and to provide ideas and methods for expanding the capacity of high-quality medical resources.Methods The medical records of patients discharged in 2020 were collected from the hospital information system,1881 patients who were hospitalized for more than 30 days were selected as the study group,and 1881 patients who were hospitalized for less than 30 days were selected as the control group by case-control matching with the discharge department as the matching condition.The general characteristics,clinical characteristics and cost cha-racteristics of the two groups were compared and analyzed.Logistic regression was used to analyze the influencing factors of patients with ultra-long hospital stay.Results Patients with extremely long hospitalization days had the most hospitalization days of 30-39 days,and the male-female ratio was 1.17∶1.Most of the patients were manual workers(44.02%),married(83.47%),long-distance patients within the province(62.95%),residents'medical insu-rance(33.33%),outpatient hospitalization(75.06%),untransferred department(63.10%),patients with other diseases(97.56%),and tumor patients(55.80%).The proportion of physical labor,total public expense/total self-expense,divorced/widowed/unmarried,emergency hospital admission,hospital transfer,accompanied by other diseases,surgery,primary surgery,pathological examination and the average cost per time were higher than those in the control group(P<0.05).Logistic analysis showed that full public expense,full self-expense,commercial medical insu-rance,unmarried,manual labor,living outside the province,accompanied by other diseases,hospital transfer,cancer patients were the risk factors of long hospital stay.Conclusion Ultra-long hospital stay is affected by many factors,and its improvement also needs to be promoted by many departments.Long hospitalization days are the performance of low efficiency of hospitals,exposing the insufficiency of medical quality and safety,and affecting the"endogenous"expansion of high-quality medical resources in hospitals.Therefore,high-risk factors should be taken as the entry point to reduce hospitalization days and expand the capacity of high-quality medical resources.