某三级医院迁建项目的医疗资源疏解效果分析

Analysis on the effect of medical resource reallocation in the relocation project of a tertiary hospital

目的分析北京市某三级医院迁建项目对首都功能核心区(以下简称核心区)神经外科住院量的影响,为进一步完善医疗资源疏解政策提供参考。方法资料来源于北京市出院病人数据表和医疗统计工作月报表。分析某三级医院(A医院)迁建前后核心区二级及以上医院,以及A医院及其老院区周边5公里内的3家三级医院(B医院、C医院和D医院)的神经外科月均住院量、外科床位数和床位使用率。2017年11月至2018年8月和2018年11月至2019年8月分别作为A医院迁建前后的时间范围。结果核心区二级及以上医院神经外科月均住院量、外地患者住院量和本地患者住院量分别从A医院迁建前的2238人次、1610人次和628人次下降至迁建后的1526人次、996人次和530人次,住院量差异均有统计学意义(P<0.001);A医院和B医院的神经外科住院量分别从983人次和659人次增加至1316人次和934人次;C医院和D医院的神经外科住院量变化不大。A医院迁建后,核心区二级及以上医院外科床位由5213张减少至4782张,A医院的外科床位由557张增加增加至750张,其余3家三级医院的外科床位数不变;4家医院床位使用率变化均<7.00%。结论A医院迁建后,核心区神经外科整体住院量下降,且主要以外地患者减少为主,医疗资源疏解取得初步成效,但同时应关注替代医疗资源对疏解效应的影响。

Objective To analyze the impact created by the reallocation of a tertiary hospital on the neurosurgery inpatients volume in the functional core area of Beijing as the capital city,for reference to improve the healthcare resource reallocation policy.Methods The data were obtained from the data sheet of discharged patients and the monthly report of medical statistics in Beijing.The study analyzed the average monthly neurosurgery inpatients volume,surgical beds and bed utilization rate of secondary or higher level hospitals from the core area,a tertiary hospital(hospital A),and as well as three tertiary hospitals(hospitals B,C and D)within 5 kilometers of Hospital A original location before and after the reallocation of Hospitls A.Periods of November 2017 to August 2018 and November 2018 to August 2019 respectively serve as the time frame before and after the relocation of Hospital A.Results After the reallocation,the average monthly total inpatients volume,inpatients volume from other places,and local inpatients volume of neurosurgery at secondary or higher level hospitals in the core area decreased from 2238,1610 and 628 to 1526,996 and 530 respectively.The inpatients volume changes were all statistically different(P<0.001).The number of neurosurgery inpatients in Hospital A and Hospital B increased from 983 and 659 to 1316 and 934 respectively,as well as the number of neurosurgery inpatients in Hospital C and Hospital D did not change much.After the relocation of Hospital A,the number of surgical beds in secondary or higher level hospitals in the core area was reduced from 5213 to 4782,while that of Hospital A increased from 557 to 750,while the other three tertiary hospitals remained unchanged.The changes of bed utilization rate of the 4 hosptials were all less than 7.00%.Conclusions After the reallocation Hospital A,the neurosurgery inpatient volume in the core area decreased,which was mainly contributed by the decrease of patients from other places,suggesting a positive outcome by the reallocation of healthcare resources in Beijing.On the other hand,it is necessary to study the influence of alternative medical resources on the reallocation effect.