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目的分析超长住院日患者的分布特征与影响因素,探讨缩短平均住院日的措施,为提高医疗机构的经济效益与社会效益提供参考。方法提取北京市某三甲医院2014年度37337例出院患者病案首页信息,以住院日≥42天为标准找出381例超长住院日患者,分析其的性别构成、年龄、住院日、出院科室和ICD-10疾病名称的分布情况,通过Logistic回归分析确定超长住院日的影响因素。结果 381例超长住院日患者中男性患者比例高于女性,平均年龄65.53岁,平均住院日为72.19天,出院科室构成比前5名的科室依次为神经内科、普外科、特需医疗部、急诊科和神经外科,ICD病种构成比前5名的疾病为循环系统疾病、肿瘤、神经系统疾病、呼吸系统疾病和影响健康状态和与保健机构接触的因素。经多分类变量的回归分析,年龄、住院期间是否转科、离院方式、是否为特需患者、是否进行手术和ICD-10疾病名称对超长住院日的影响具有统计学意义(P均<0.05)。结论上级卫生行政管理部门和医疗机构应加强医联体建设,疏通转诊渠道,积极开展临床路径,加快实施DRGs预定额付费制。医疗机构还应加强对住院超过30天患者的管理,建立预警机制,针对重点科室、重点病种加强监管,多管齐下缩短平均住院日。
Objective To analyze the distribution characteristics and influential factors of over-long hospitalized patients and to explore measures to shorten the average length of stay so as to provide reference for improving the economic and social benefits of medical institutions. Methods A total of 37337 cases of discharged patients in a certain grade A hospital in Beijing were extracted from the first page of their medical records. 381 cases of over-hospitalized patients were identified on the basis of ≥42 days of in-hospital stay. Their sex composition, age, hospitalization days, discharge departments and ICD -10 distribution of disease names, Logistic regression analysis to determine the factors influencing the length of stay. Results The proportion of males in 381 super-long hospital days was higher than that of females, with an average age of 65.53 years and an average length of hospitalization of 72.19 days. Discharge departments were the top five departments of neurology, general surgery, special medical department, emergency department Department of Neurosurgery, ICD The top 5 diseases that make up the disease are circulatory, oncological, neurological, respiratory, and those affecting health status and access to healthcare facilities. The regression analysis of multiple classification variables, age, whether hospital transfer during hospitalization, leaving the hospital, whether the patients with special needs, whether the operation and ICD-10 disease name on the length of stay longer were statistically significant (all P <0.05 ). Conclusion Higher-level health administrative departments and medical institutions should strengthen the construction of Medical Association, clear the referral channels, and actively carry out clinical pathways to speed up the implementation of DRGs pre-payment system. Medical institutions should also strengthen the management of patients who have been hospitalized for more than 30 days, set up an early warning mechanism, strengthen supervision over key departments and key diseases, and reduce the average length of stay by a multi-pronged approach.