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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (1): 102-107.doi: 10.6040/j.issn.1671-7554.0.2020.0983

• 公共卫生与管理学 • 上一篇    下一篇

基于广义估计方程的某三甲医院超长住院日影响因素分析

李向一1,王清亮1,张永媛1,刘盈君1,费剑春1,杨杰1,张义2   

  1. 山东大学齐鲁医院 1. 医务处;2. 检验科, 山东 济南 250012
  • 发布日期:2021-01-09
  • 通讯作者: 张义. E-mail:zhangyi-3144@163.com杨杰. E-mail:yang64662003@163.com
  • 基金资助:
    山东大学齐鲁医院住院医师规范化培训创新性研究专项(ZPZX2017A05)

Analysis of influencing factors of prolonged length of stay in a tertiary hospital based on generalized estimation equation

LI Xiangyi1, WANG Qingliang1, ZHANG Yongyuan1, LIU Yingjun1, FEI Jianchun1, YANG Jie1, ZHANG Yi2   

  1. 1. Medical Department;
    2. Laboratory Department, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2021-01-09

摘要: 目的 基于广义估计方程(GEE)探讨超长住院日患者的分布特征及影响因素。 方法 收集济南市某三甲医院2015年1月1日至2019年12月31日期间全部出院患者的病案首页信息,采用GEE模型对超长住院日的影响因素进行分析。 结果 近5年超长住院日患者共计7 613人次,占纳入分析人次的1.00%。超长住院日患者人数分布较高的科室为肿瘤中心、小儿内科和普通外科,疾病类目以肿瘤(C00-D48)为主;GEE模型结果显示,年龄、性别、入院途径、住院期间转科、合并症、手术、非计划再住院、离院方式是超长住院日的影响因素。 结论 超长住院日对整体平均住院日影响严重,医院应对超长住院日患者加强管理,缩短平均住院日,提高医疗资源利用率。

关键词: 超长住院日, 广义估计方程, 分布特征, 影响因素, 医院管理

Abstract: Objective To analyze the distribution characteristics and risk factors of inpatients with prolonged length of stay based on generalized estimation equation(GEE). Methods Medical records of inpatients treated in a tertiary hospital in Jinan during Jan. 1, 2015 and Dec. 31, 2019 were collected. The influencing factors of prolonged length of stay were analyzed with GEE. Results A total of 7 613 inpatients with prolonged length of stay were enrolled, accounting for 1.00% of all patients included in the analysis. The departments with the highest number of patients with prolonged length of stay were Cancer Center, Departments of Pediatrics and General Surgery, and most patients had tumors. GEE showed that age, gender, admission route, inter-department transfer, comorbidities, surgeries, unplanned readmission, and discharge route were influencing factors of prolonged length of stay. Conclusion Prolonged length of stay has a significant impact on the overall average length of stay. Effective measures should be taken to strengthen the management of such patients, shorten the average length of stay and improve the utilization of medical resources.

Key words: Prolonged length of stay, Generalized estimation equation, Distribution characteristics, Influencing factors, Hospital administration

中图分类号: 

  • R197.3
[1] 周昀, 何露佳, 程永忠, 等. 基于国内外平均住院日管理现状分析[J]. 中国卫生事业管理, 2017, 34(10): 739-742. ZHOU Yun, HE Lujia, CHENG Yongzhong, et al. The status analysis of management of average length of stay at home and abroad [J]. Chinese Health Service Management, 2017, 34(10): 739-742.
[2] 吴学智. 某三甲医院超长住院日患者分布特征及影响因素分析[J]. 中国卫生统计, 2019, 36(4): 522-524.
[3] 凌爱芳. 某院1740例超长住院日患者影响因素分析[J]. 中国卫生统计, 2017, 34(1): 102-103.
[4] 刘明, 顾琳. 某三甲医院超长住院日病例统计分析[J]. 中国卫生统计, 2018, 35(3): 443-444.
[5] 汪雅璇, 李书, 郭亚楠, 等. 基于合理平均住院日的我国医院资源优化配置研究与预测[J]. 中华医院管理杂志, 2016, 32(5): 365-368. WANG Yaxuan, LI Shu, GUO Yanan, et al. Optimal allocation of hospital resources in China based on reasonable average das of stay: research and prediction [J]. Chinese Journal of Hospital Administration, 2016, 32(5): 365-368.
[6] 聂静, 刘佳. 超长住院日患者分布特征与影响因素分析[J]. 中国医院管理, 2015, 35(8): 44-46. NIE Jing, LIU Jia. Distribution characteristics and influencing factors of super long hospitalization days [J]. Chinese Hospital Management, 2015, 35(8): 44-46.
[7] 喻文菡, 陶红兵, 何金露, 等. 三级综合医院住院日≥30天患者分布特征及影响因素分析[J]. 中华医院管理杂志, 2017, 33(7): 515-518. YU Wenhan, TAO Hongbing, HE Jinlu, et al. Analysis on distribution characteristics and risk factors of extended stay at tertiary comprehensive hospitals [J]. Chinese Journal of Hospital Administration, 2017, 33(7): 515-518.
[8] Lee SY, Lee S, Tan JHH, et al. Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review [J]. BMC Health Serv Res, 2018, 18(1): 5. doi: 10.1186/s12913-017-2817-8.
[9] 姚敏, 罗奕, 王晓颖. 口腔医院超长住院日病例统计与分析[J]. 中国卫生统计, 2015, 32(1): 73-74.
[10] 王玲, 王承珠, 缑文海. 某院316例超长住院日病例统计分析[J]. 中国卫生统计, 2015, 32(2): 367-368.
[11] 韩芳, 阿曼古力·依布拉音, 米热古丽·哈米提, 等. 肺癌患者超长住院天数影响因素分析[J]. 中国卫生统计, 2017, 34(02): 260-262.
[12] 王健, 聂良华, 严志刚, 等. 某三甲医院超长住院日患者分布特征与影响因素分析[J]. 中国病案, 2019, 20(7): 52-56. WANG Jian, NIE Lianghua, YAN Zhigang, et al. The distribution characteristics and analysis of influencing factors of over-long hospitalization days in a three A and tertiary hospital [J]. Chinese Medical Record, 2019, 20(7): 52-56.
[13] Turcotte LA, Perlman CM, Fries BE, et al. Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals [J]. BMC Health Serv Res, 2019, 19(1): 218. doi: 10.1186/s12913-019-4024-2.
[14] Hosseini H, Pai D, Ofak D. COPD: Does inpatient education impact hospital costs and length of stay? [J]. Hosp Top, 2019, 97(4): 165-175.
[15] Newman L, Harris V, Evans LJ, et al. Factors associated with length of stay in psychiatric inpatient services in London, UK [J]. Psychiatr Q, 2017, 89(5): 33-43.
[16] Mai D, Brand C, Haschtmann D, et al. Non-medical factors significantly influence the length of hospital stay after surgery for degenerative spine disorders [J]. Eur Spine J, 2020, 29(2): 203-212.
[17] DAgostino F, Vellone E, Cocchieri A, et al. Nursing diagnoses as predictors of hospital length of stay: a prospective observational study [J]. J Nurs Scholarsh, 2018, 51(1): 96-105.
[18] Song X, Xia C, Li Q, et al. Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China [J]. BMC Musculoskelet Disord, 2020, 21(1): 62. doi: 10.1186/s12891-020-3042-x.
[19] Strother MC, Michel KF, Xia L, et al. Prolonged length of stay after robotic prostatectomy: causes and risk factors [J]. Ann Surg Oncol, 2020, 27(5): 1560-1567.
[20] Marfil-Garza BA, Belaunzarán-Zamudio PF, Gulias-Herrero A, et al. Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico [J]. PLoS One, 2018, 13(11): e0207203. doi: 10.1371/journal.pone.0207203.
[21] Lü Y, Cai MH, Cheng J, et al. A multi-center nested case-control study on hospitalization costs and length of stay due to healthcare-associated infection [J]. Antimicrob Resist Infect Control, 2018, 7: 99. doi: 10.1186/s13756-018-0386-1.
[22] Giraldi G, Montesano M, Sandorfi F, et al. Excess length of hospital stay due to healthcare acquired infections: methodologies evaluation [J]. Ann Ig, 2019, 31(5): 507-516.
[23] Shaw E, Gomila A, Piriz M, et al. Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery [J]. J Hosp Infect, 2018, 100(4): 400-405.
[24] Lampros A, Montardi C, Journeau L, et al. Association between psychiatric comorbidities and hospital length of stay in post-emergency internal medicine patients [J]. Rev Med Interne, 2020, 41(6): 360-367.
[25] 陈虹, 张勇, 吴昊, 等. 合理控制平均住院日的实践与思考[J]. 中华医院管理杂志, 2011, 27(1): 16-18.
[26] 沈韬, 金昌晓, 陈仲强. 信息化建设对提高服务效率和保障医疗安全的作用[J]. 中华医院管理杂志, 2010, 26(11): 865-867.
[27] 袁磊, 李亮, 钱招昕, 等. 开展日间手术对平均住院日影响的间断时间序列分析[J]. 中华医院管理杂志, 2018, 34(10): 805-809. YUAN Lei, LI Liang, QIAN Zhaoxin, et al. Interrupted time series analysis for impacts of day surgery on average days of stay [J]. Chinese Journal of Hospital Administration, 2018, 34(10): 805-809.
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