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某精神病专科医院非医嘱离院影响因素的Logistic回归分析

Logistic Regression Analysis on Influencing Factors of Discharge Against Medical Advice in a Psychiatric Hospital
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摘要 目的 分析某精神病专科医院非医嘱离院患者的相关特征及影响因素,为加强医院管理,提高医疗服务质量提供参考。方法 从病案统计系统调取2019年7月1日-2021年6月30日出院患者数据16842例,根据离院方式分为医嘱离院组和非医嘱离院组,采用Logistic回归分析非医嘱离院的相关因素。结果16842例出院患者中,医嘱离院16077例,非医嘱离院765例。Logistic回归分析显示付费方式(自费,OR=1.51)、住院天数(大于等于35天,OR=0.23)、入院病情(临床未确定、情况不明和无,OR=1.45)、现住址(外地,OR=1.20)是造成患者非医嘱离院的主要影响因素。非医嘱离院患者中自费者占27.71%,住院天数<35天占85.62%,入院病情临床未确定、情况不明和无者占7.58%,居住在外地者占60.26%;医嘱离院患者中自费者占18.22%,住院天数<35天占47.56%,入院病情临床未确定、情况不明和无者占4.37%,居住在外地者占52.36%。非医嘱离院位居首位的疾病类型是心境情感障碍,占48.89%;而医嘱离院位居首位的疾病类型是精神分裂症、分裂型障碍和妄想性障碍,占39.25%。结论 自费、入院病情临床未确定,情况不明和无、居住在外地和住院天数<35天是影响患者非医嘱离院的重要因素,医院应采取针对性的措施,减少非医嘱离院的发生。 Objectives To analyze the relevant characteristics and influencing factors of discharge against medical advice in a psychiatric hospital, and to provide references for strengthening hospital management and improving the quality of medical services. Methods The data of 16842 discharged patients from July 1st, 2019 to June 30th, 2021 were retrieved from the medical record statistics system. All research subjects were divided into the group of patients who left the hospital against medical advice and the group of patients who left the hospital with medical advice. Logistic regression was used to analyze the related factors of discharge against medical advice.Results Among the 16,842 discharged patients, 16077 were discharged inpatients with medical advice and 765 were discharged inpatients against medical advice. Logistic regression analysis showed that payment method(self-financed, OR=1.51), length of hospital stay(≥35 days, OR=0.23), condition of admission(clinically uncertain, unclear and no, OR=1.45), current address(outland, OR=1.20) were the main influencing factors that caused patients to leave the hospital against medical advice. Among the 765 discharged inpatients against medical advice, the proportion of self-payers was 27.71%, hospitalization less than 35 days was 85.62%, admission without medical conditions was 7.58% and living outside was 60.26%. Among the 16077 discharged inpatients with medical advice, the proportion of self-payers was 18.22%, hospitalization less than 35 days was 47.56%,admission without medical conditions was 4.37% and living outside was 52.36%. The most common type of diseases discharged from hospital against medical advice was mood disorder, accounting for 48.89%. The most common type of diseases discharged from hospital with medical advice was schizophrenia, schizophrenic disorder and delusional disorder, accounting for 39.25%. Conclusions Self-payers, admission without medical conditions,living outside and hospitalization less than 35 days are important factors that affect patients leaving the hospital against medical advice. The hospital should take targeted measures, pay attention to key populations of key diseases, and provide appropriate post-discharge guidance, so as to reduce the occurrence and negative impact of discharge against medical advice.
作者 王智慧 闫军伟 Wang Zhihui;Yan Junwei(The Affliated Psychological Hospital of Anhui Medical University,Anhui Mental Health Center,The Fourth People's Hospital of Hefei,Hefei 230031,Anhui Province,China;不详)
出处 《中国病案》 2023年第2期86-89,共4页 Chinese Medical Record
基金 合肥市卫健委应用医学重点研究项目(编号:Hwk2021zd011) 合肥市第四人民医院院内科研项目(项目编号:HFSY2020YB13)。
关键词 非医嘱离院 LOGISTIC回归 影响因素 医院管理 Discharge against medical advice Logistic regression Influencing factor Hospital management
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