2018-2019年河南省南阳市某三甲医院出院患者再住院影响因素分析

Influencing factors of re-admission of discharged patients from a three-A-level tertiary hospital in Nanyang city,Henan province from 2018 to 2019

目的探讨出院患者再住院的影响因素,为提高医疗质量,节约卫生资源提供依据。方法对2018-2019年南阳市某三甲医院出院31 d内非计划再住院患者病历资料进行回顾性分析。结果2018-2019年南阳市某三甲医院共出院患者130629人次,31 d内非计划再住院1296人次,再住院率0.99%。其中,男性和女性患者再住院率分别为1.18%(762/64831)和0.81%(534/65798),差异有统计学意义(χ^(2)=43.997,P<0.05);不同年龄组中,35~44岁患者再住院率最高为1.63%(184/11312),<15岁患者最低为0.27%(76/27850),差异有统计学意义(χ^(2)=229.550,P<0.05)。不同科室中,内分泌科患者再住院率最高为5.61%(44/784),儿科最低为0.07%(17/23165),差异有统计学意义(χ^(2)=874.766,P<0.05)。不同医疗付款方式中,全部公费患者再住院率最高为48.33%(202/418),城乡居民医保患者再住院率最低为0.50%(327/65132),差异有统计学意义(χ^(2)=9912.987,P<0.05)。不同病种中,内分泌、营养和代谢疾病患者再住院率最高为4.74%(108/2279),其他疾病再住院率最低为0.11%(29/27196),差异有统计学意义(χ^(2)=823.037,P<0.05)。多因素logistic回归分析显示,以女性患者为参照,男性患者(OR=0.560,95%CI:0.496~0.633)再住院率高;以<15岁患者为参照,15~24岁组患者(OR=5.091,95%CI:3.030~8.552)、25~34岁组患者(OR=3.258,95%CI:1.971~5.386)、≥65岁患者(OR=2.635,95%CI:1.612~4.309)再住院率高;以肿瘤科患者为参照,心内科患者(OR=12.839,95%CI:8.814~18.702)、神内科患者(OR=8.616,95%CI:5.998~12.375)、呼吸科患者(OR=7.539,95%CI:5.148~11.038)、内分泌科患者(OR=5.901,95%CI:3.553~9.801)再住院率高;以城乡居民医保患者为参照,全部公费患者(OR=4.147,95%CI:2.617~6.570)、其他患者(OR=1.286,95%CI:1.076~1.538)再住院率高;以其他疾病患者为参照,泌尿系统疾病患者(OR=5.266,95%CI:3.841~7.222)、肿瘤系统疾病患者(OR=3.645,95%CI:2.608~5.094)、内分泌、营养和代谢疾病患者(OR=0.638,95%CI:0.462~0.881)再住院率高。结论合理利用医疗资源,降低再住院率需要多方面共同努力。国家层面应做好宣传教育工作,提高全民医疗保健水平;医疗保障局应加大综合监管力度,减少过度医疗;医院方面应提高疑难疾病的诊治能力,减少常见病、慢性病的复发率;患者应坚持正规治疗,提高遵医行为,减少疾病的复发,降低再住院率。

Objective To explore the influencing factors of re-admission of discharged patients,and provide the evidence for improving medical quality and saving health resources.Methods The data of discharged patients re-admitted within 31 days from 2018 to 2019 in a three-A-level tertiary hospital in Nanyang were analyzed retrospectively.Results From 2018 to 2019,a total of 130629 patients were discharged from the three-A-level tertiary hospital in Nanyang,and 1296 of them re-admitted to the hospital without a plan within 31 days,with re-admission rate of 0.99%(1296/130629).Among them,the rates of re-admission in males and females were 1.18%(762/64831)and 0.81%(534/65798),respectively.The difference was statistically significant(χ^(2)=43.997,P<0.05).Among different age groups,the highest rate of re-admission was seen in patients aged 35 to 44 years,which was 1.63%(184/11312),and the lowest rate was 0.27%(76/27850),which was seen in patients younger than 15 years old,with a statistically significant difference(χ^(2)=229.550,P<0.05).In different departments,the highest rate of re-admission was seen in endocrinology patients,which was 5.61%(44/784);the lowest rate was 0.07%(17/23165),which was seen in paediatrics;the difference was statistically significant(χ^(2)=874.766,P<0.05).Among different medical payment methods,the highest rate of re-admission was seen in publicly funded patients,which was 48.33%(202/418),and the lowest rate was 0.50%(327/65132),which was seen in urban and rural residents with medical insurance.The difference was statistically significant(χ^(2)=9912.987,P<0.05).Among different diseases,the highest rate of re-admission was seen in endocrine,nutritional and metabolic diseases,which was 4.74%(108/2279),while the lowest rate was seen in other diseases was 0.11%(29/27196).The difference was statistically significant(χ^(2)=823.037,P<0.05).The multivariable logistic regression analysis showed that taking female patients as reference,male patients(OR=0.560,95%CI:0.496-0.633)had a high readmission rate;taking patients aged<15 years old as the reference,patients in 15-24 years old group(0R=5.091,95%CI:3.030-8.552),patients in 25-34 years old group(OR=3.258,95%CI:1.971-5.386),and patients aged≥65 years old group(OR=2.635,95%CI:1.612-4.309)had a high rate of re-admission;taking oncology patients as reference,cardiology patients(OR=12.839,95%Cl:8.814-18.702),orthopaedics patients(OR=8.616,95%CI:5.998-12.375),respiratory patients(OR=7.539,95%CI:5.148-11.038),endocrinology patients(OR=5.901,95%CI:3.553-9.801)had a high rate of re-admission;Taking urban and rural residents medical insurance patients as a reference,patients with all public expenses(OR=4.147,95%CI:2.617-6.570)and other patients(OR=1.286,95%CI:1.076-1.538)had a high rate of re-admission.Taking patients with other diseases as reference,patients with urinary system diseases(OR=5.266,95%CI:3.841-7.222),patients with tumor system diseases(OR=3.645,95%CI:2.608-5.094),patients with endocrine,nutritional and metabolic diseases(OR=0.638,95%CI:2.608-5.094)had a high rate of re-admission.Conclusions The rational use of medical resources and the reduction of re-admission rate require the joint efforts of all parties.Our country should do a good job in publicity and education,and improve the health level of the whole population;the medical insurance bureau should increase comprehensive supervision and reduce excessive medical treatment;hospitals should improve the ability to diagnose and treat difficult diseases,and reduce the recurrence rate of common and chronic diseases;patients should adhere to regular treatment,improve compliance behaviors,and reduce disease recurrence for finally reducing the rate of re-admission.