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目的了解患者非医嘱离院现状及相关特征。方法利用某院2015年出院患者数据,应用卡方检验和秩和检验分析非医嘱离院与医嘱离院成年患者的特征区别,应用多因素logistic回归分析比较不同患者特点与非医嘱离院的因果关系。结果某院2015年成年患者出院42 682人次,非医嘱离院率为5.8%。非医嘱离院患者年龄中位数为56(35~71)岁,较医嘱离院患者年龄大(P<0.001);中位住院天数为5(3~10)天,中位住院费用为0.65(0.37~1.34)万元,均较医嘱离院患者少(P<0.001)。男性(OR=1.58,95%CI1.43~1.75)、急诊入院(OR=1.25,95%CI 1.14~1.37)、全自费(OR=1.55,95%CI 1.41~1.70)、有抢救(OR=3.37,95%CI 2.80~4.07)是非医嘱离院的危险因素,而中年(31~50岁)(OR=0.74,95%CI 0.64~0.85)、入院病情明确(OR=0.75,95%CI 0.68~0.82)、有手术操作(OR=0.57,95%CI 0.51~0.63)、多次在该院住院(OR=0.78,95%CI 0.71~0.86)是非医嘱离院的保护因素。不同科室的非医嘱离院危险性不同(P<0.001)。结论成年医嘱离院与非医嘱离院患者就诊特征存在差别,可采取针对性措施降低非医嘱离院率,利于患者的身体健康和提高医院的社会效益和经济效益。
Objective To understand the status quo of non-doctor’s orders and the related characteristics. Methods The data of discharged patients in a hospital from 2015 to 2015 were analyzed. The differences between the characteristics of non-doctor’s orders and those of adult patients leaving hospital were analyzed by chi-square test and rank sum test. Multivariate logistic regression analysis was used to compare the characteristics of different patients with those of non-doctor’s orders relationship. Results In 2015, a total of 42 682 adult patients were discharged from hospital and 5.8% of non-doctor ordered hospitalizations. The median age was 56 (35-71) years among non-doctor-ordered patients who were discharged from hospital and older than those who were hospitalized (P <0.001). The median length of stay was 5 (3-10) days and the median hospitalization cost was 0.65 (0.37 ~ 1.34) ten thousand yuan, were less than the doctor ordered to hospital patients (P <0.001). (OR = 1.58, 95% CI 1.43 ~ 1.70), emergency (OR = 1.25,95% CI 1.14-1.37) 3.37, 95% CI 2.80 ~ 4.07) were the risk factors of non-doctor’s order leaving hospital, and middle age (31-50 years) (OR = 0.74,95% CI 0.64-0.85) (OR = 0.57, 95% CI 0.51-0.63). Repeated hospitalizations (OR = 0.78, 95% CI 0.71-0.86) were the protective factors for non-doctor’s orders. Different departments of non-doctor’s advice different from the risk (P <0.001). Conclusion There are differences in the characteristics of adult doctor ’s order between outpatient and non - doctor ordered hospitalized patients. We can take pertinent measures to reduce the rate of non - doctor’ s leaving hospital, which will benefit the patients ’health and enhance the hospital’ s social and economic benefits.