住院日超过60天病例的影响因素分析

Analysis of Influencing Factors of Cases with Hospitalization Days Exceeding 60 days

目的分析住院日超过60天病例的影响因素,探讨缩短平均住院日的方法。方法从江苏省某三甲医院2020年1月1日-2020年12月31日住院病案首页中筛选出住院日>60天的549份病案(实验组)和随机抽取同期549份住院日≤60天的病案(对照组)为研究对象,对比2组的性别、年龄、医保支付方式、转科情况、出院科别等不同住院特征。结果实验组患者的高龄、男性、全公费、转科、内科、死亡、非肿瘤患者、住入ICU和有手术等的比例均高于对照组患者(P<0.05);多因素回归分析发现:男性、转科、死亡、非肿瘤患者和住入ICU均是影响住院日超过60天的影响因素(P<0.05);年龄>70岁患者产生超过60天住院日的风险是年龄≤40岁的患者的2.306倍;全公费患者产生超过60天住院日的风险是有医保或社保患者的8.006倍,全自费患者产生超过60天住院日的风险是有医保或社保患者的1.804倍。结论住院日超过60天病例的产生与男性、高龄、全公费、转科、死亡、不患肿瘤和住入ICU密切相关,医院对于超过60天住院日的管理可根据其影响因素制定相应的防治对策,减少非必要的大量住院日过长病例,从而降低平均住院日。

Objectives This study aims to analyze the influencing factors of cases with hospitalization days exceeding 60 days and explore ways to shorten the average hospital stay.Methods 549 medical records with hospitalization days exceeding 60 days(experimental group)and random samples of 549 medical records with hospitalization days no more than 60 days(control group)from January 1,2020 to December 31,2020 were screened out from medical record front pages in a tertiary hospital of Jiangsu Province.This study compared the different hospitalization characteristics such as gender,age,medical insurance payment method,department transfer,and discharge department between the two groups.Results The proportions of the patients in the experimental group were higher than those in the control group in terms of advanced age,male,full public expense,transfer to department,internal medicine,death,non-tumor patients,ICU admission and surgery(P<0.05).Multivariate regression analysis indicated that male,transfer to department,death,non-tumor patients and ICU admission were all influencing factors for the occurrence of medical records with hospitalization days longer than 60days(P<0.05).Patients aged>70 years had a 2.306 times higher risk of hospitalization for more than 60 days compared with patients aged≤40 years.The risk of hospitalization for more than 60 days for fully funded patients is 8.006 times that for patients with medical insurance or social security.Self-pay patients have 1.804 times the risk of having more than 60 days of hospital stay than patients with medical insurance or social security.Conclusions The occurrence of cases with hospitalization days exceeding 60 days is closely related to males,advanced age,full public expense,transfer to department,death,absence of tumor and admission to ICU.For the management of hospitalization days exceeding 60 days,the hospital can formulate corresponding prevention and treatment strategies according to its influencing factors and reducing the number of unnecessary cases of long hospitalization days so as to reduce the average length of hospital stay.