摘要
目的:分析某三甲综合医院住院≥30天出院患者的分布特征及影响因素,为有效控制住院天数提供参考依据。方法:收集该院2020年1月1日-2023年12月31日全部出院患者病案首页数据,对其中7 294例住院≥30天患者分布特征进行描述性分析,将单因素分析中有统计学意义的指标纳入Logistic多元回归分析住院≥30天的影响因素。结果:Logistic多元回归显示,男性、年龄、疑难或危重、转科、院内感染、急诊入院、医嘱转院和下转是患者住院≥30天的共同危险因素,非医嘱离院、医保病人和完成临床路径是住院≥30天的共同保护因素。对于手术患者,非计划二次手术、医嘱转社区卫生服务机构/乡镇卫生院也是危险因素。对于非手术患者,抢救、其他医疗机构转入也是危险因素。结论:医疗机构应针对影响因素加强全流程管控、优化诊治流程、完善分级诊疗制度、建立多学科协作诊疗、强化临床路径管理,在保证医疗质量安全的前提下,有效缩短住院时间,提升医疗资源使用效率。
Objective:To analyze the distribution characteristics and influencing factors of discharged patients who were hospitalized for more than 30 days from a certain grade A tertiary general hospital,and provide reference for effective control of hospitalization days.Method:By collecting the medical records of all discharged patients from a certain grade A tertiary general hospital from January 1,2020 to December 31,2023,descriptive analysis was conducted on the distribution characteristics of 7294 patients who were hospitalized for more than 30 days.The statistically significant indicators in univariate analysis were included in logistic multiple regression analysis to analyze the influencing factors of hospitalization for more than 30 days.Results:Logistic multiple regression analysis showed that male gender,age,critical or severe condition,transfer between departments,hospital-acquired infection,emergency admission,physician’s order for transfer,and referral to lower level.healthcare facility are common risk factors for patients staying in the hospital for more than 30 days.non-physician order discharge Medical insurance patients and completion of clinical pathways are common protective factors for staying in the hospital for more than 30 days.For surgical patients,unplanned second surgery and transfer to a lower-level hospital are also risk factors for staying in the hospital for more than 30 days.For non-surgical patients,resuscitation and transfer from other medical institutions are also risk factors for staying in the hospital for more than 30 days.Conclusion:Medical institutions should strengthen full-process control,optimize diagnostic and treatment processes,improve the hierarchical diagnosis and treatment system,establish MDT(Multi-Disciplinary Treatment)model,and strengthen clinical pathway management.While ensuring the quality and safety of medical care,effectively reduce the length of hospital stay and improve the efficiency of medical resource utilization.
作者
陶源
狄佳
杨彧
曹玲
TAO Yuan;DI Jia;YANG Yu;CAO Ling(Quality Management Department,The First People’s Hospital of Changzhou,Changzhou,Jiangsu,213003)
出处
《江苏卫生事业管理》
2025年第1期53-58,62,共7页
Jiangsu Health System Management
关键词
住院时间
分布特征
影响因素
Hospitalization Length of Stay
Distribution Characteristics
Influence Factors
