2018年济南市某三甲医院31天内非计划再入院研究

doi:10.6040/j.issn.1671-7554.0.2019.1457

摘要/Abstract

摘要： 目的了解济南市某三甲医院31天内非计划再入院的现状与影响因素。方法对2018年1月1日~12月31日济南市某三甲医院非计划再入院患者2828人次进行描述性统计分析及影响因素分析。结果 2018全年非计划再入院率1.79%,非计划再入院患者死亡率2.76%;非计划再入院率较高的科室为肝病科、风湿科和干部保健科,病种以慢性病和恶性肿瘤为主;患者年龄(OR=1.025,95%CI:1.023~1.028)、前次住院天数(OR=1.021,95%CI:1.018~1.025)、住院次数(OR=1.094,95%CI:1.087~1.101)、居住地区(OR=1.346, 95%CI: 1.244~1.455)、婚姻状况(未婚:OR=3.280,95%CI:2.788~3.859;丧偶:OR=1.954,95%CI:1.502~2.541)、前次离院方式(非医嘱离院:OR=1.406,95%CI:1.173~1.685)、前次是否手术(OR=0.628,95%CI:0.577~0.684),是否医保患者(OR=0.594,95%CI:0.537~0.657)是影响非计划再入院的重要因素。结论医院应完善非计划再入院的监管,规范诊疗过程,避免分解住院行为,推进实施分级诊疗制度,正确引导患者需求,降低非计划再入院率,减轻患者负担。

关键词: 非计划再入院, 医疗质量, 分级诊疗, 慢性病, 影响因素

Abstract: Objective To investigate the current status and influencing factors of unplanned readmission within 31 days after discharge in a tertiary hospital in Jinan. Methods A total of 2828 inpatients of unplanned readmission with 31 days during January 1st and December 31st, 2018 were enrolled. The descriptive analysis was employed, and Logistic regression was conducted to analyze the influencing factors. Results The unplanned readmission rate was 1.79%, and the mortality of unplanned readmission inpatients was 2.76%. The departments with high unplanned readmission rate focused on Department of Hepatology, Department of Rheumatology and Department of Geriatrics, and mainly due to chronic diseases and malignant tumors. The major influencing factors were inpatients age(OR=1.025,95%CI:1.023-1.028), previous length of stay in hospital(OR=1.021,95%CI:1.018-1.025), hospitalization times(OR=1.094,95%CI:1.087-1.101), district(OR=1.346, 95%CI: 1.244-1.455), marital status(unmarried: OR=3.280,95%CI:2.788-3.859; widowed: OR=1.954,95%CI:1.502-2.541), previous ways of discharge(discharge without doctors advice: OR=1.406,95%CI:1.173-1.685), previous operation(OR=0.628,95%CI:0.577-0.684)and medical insurance status(OR=0.594,95%CI:0.537-0.657). Conclusion The hospital should improve the supervision of unplanned readmission, standardize the diagnosis and treatment process, avoid decomposition of hospitalization, promote the hierarchical medical system, correctly guide the needs of patients, reduce the unplanned readmission rate and lighten the burden of patients.

Key words: Unplanned readmission, Medical quality, Hierarchical medical system, Chronic diseases, Influencing factor

中图分类号:

R197.3

张永媛,王清亮,李向一,刘盈君,费剑春,杨杰. 2018年济南市某三甲医院31天内非计划再入院研究[J]. 山东大学学报 (医学版), 2020, 58(2): 90-95.

ZHANG Yongyuan, WANG Qingliang, LI Xiangyi, LIU Yingjun, FEI Jianchun, YANG Jie. A study of unplanned readmission within 31 days during 2018 in a tertiary hospital in Jinan[J]. Journal of Shandong University (Health Sciences), 2020, 58(2): 90-95.

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