摘要
目的分析和探讨某三级医院恶性肿瘤住院患者非医嘱离院的原因及影响因素,制定有针对性的预防措施。方法依据病案首页信息查询2020年1月1日-2020年12月31日某院肿瘤科出院患者1989例,其中非医嘱离院患者211例,逐一核对病案资料,对非医嘱离院原因及影响因素进行分析。结果恶性肿瘤非医嘱离院率10.61%,平均年龄(52.12±14.98)岁;男女比例为1.17:1;职工居民医保75例(12.28%),新农合医保41例(8.45%),商业医保35例(8.45%),全自费患者60例(12.53%);非医嘱离院前3位原因为患者经济原因36.78%,认为无继续治疗意义29.88%,要求到高一级医院治疗12.45%;疾病主要诊断前3位:肺部恶性肿瘤17.06%,肝部恶性肿瘤14.69%,急性肝衰竭13.74%;患者性别、年龄、医疗支付方式和疾病主要诊断均与非医嘱离院发生率有关,均P<0.05。结论医院应针对性根据非医嘱离院原因和影响因素制定一系列措施,采用多部门协作,积极开展人文关怀,减少非医嘱离院的发生,尽可能降低其给患者及其家庭、医院、社会造成的浪费和伤害。
Objective To analyze and explore the causes and influencing factors of leaving hospital without medical advice for cancer inpatients in a tertiary hospital, and formulate targeted preventive measures. Methods According to the information on the front page of medical records, the discharged patients and all patients leaving hospital without medical advice in the oncology department of a hospital from January 1 st, 2020 to December 31 st,2020 were inquired. All medical records were checked one by one, and the basic situation of the patients and the reasons and influencing factors of leaving hospital without medical advice were analyzed. Results From January 1 st,2020 to December 31 st, 2020, there were 1989 hospitalized patients in the department of oncology, of which 211 were patients leaving hospital without medical advice, accounting for 10.61%, with an average age of(52.12±14.98) years old;men were slightly more than women, accounting for 1.17:1;in terms of medical payment, there were 75 cases(12.28%) of employee resident medical insurance, 41 cases(8.45%) of new rural cooperative medical insurance, 35 cases(8.45%) of commercial medical insurance, and 60 cases(12.53%) of all self funded patients %The top three reasons for non doctor’s advice were too high medical expenses, too heavy family financial burden in 78 cases(36.78%), abandoning themselves and believing that there was no significance of further treatment in 63 cases(29.88%), 26 cases(12.45%) were required to be treated in a higher hospital;the top three diseases were lung cancer(17.06%), liver cancer(14.69%) and acute liver failure(13.74%);gender,age, medical payment method and main diagnosis of the disease were related to the incidence of leaving hospital without medical advice, all P<0.05. Conclusions The hospital should formulate a series of measures according to the reasons and influencing factors of leaving hospital without medical advice, adopt multi-party and multi department cooperation, actively carry out humanistic care, reduce the occurrence of leaving hospital without medical advice, and reduce the waste and harm to patients and their families, hospitals and society as far as possible.
作者
王景毅
张风岭
Wang Jingyi;Zhang Fengling(Xiang'an Branch of The First Affiliated Hospital of Xiamen University,Xiamen 361101,Fujian Province,China;不详)
出处
《中国病案》
2021年第11期71-74,共4页
Chinese Medical Record
关键词
三级综合医院
恶性肿瘤
原因分析
非医嘱离院
Tertiary general hospital
Malignant tumor
Cause analysis
Leaving hospital without medical advice
