【作者】 苗子强；

【导师】 胡建中； 吕红斌；

【作者基本信息】 中南大学 ， 外科学， 2011， 硕士

【摘要】 目的：通过分析3所医院门诊及住院病人的信息,探讨门诊及住院病人疾病构成情况以及3所医院医疗服务影响力及辐射范围,了解疾病对人群健康的影响程度,对调整和配置卫生资源提出建议和意见。方法：通过自行设计调查问卷,采取随机抽样的方法,从3所医院随机抽取门诊病人进行所患疾病类型及其地区来源的问卷调查。对问卷调查结果进行统计描述,计算门诊及住院病人患病类型、地域来源构成比等统计指标。利用2006年-2010年3所医院住院病人数据资料,运用对比分析法对住院病人的年龄、性别以及系统疾病类型、单病种疾病构成进行统计,并对3所医院住院病人疾病构成及医疗服务影响力进行对比分析。通过对数转换实现住院人次的方差齐性,运用灰色预测模型对3所医院2006-2009年住院人次数据进行模型拟合,并通过引入残差检验和后验差检验2个统计量进行模型预测效果的检验,在此基础上,进一步对3所医院2010-2015年住院人次进行预测。所有统计资料及数据采用Excel软件建立数据库,运用SPSS17.0和MATLAB软件进行统计分析和预测研究。结果：①门诊病人调查研究结果显示,被调查门诊病人中,男性占49.49%,女性占50.51%,男女性别比为98.02%。3所医院以妇产科门诊病人居多,神经内科、眼科、皮肤科和耳鼻喉科位居第2、第3、第4和第5位。从ICD-10系统疾病统计结果来看,门诊救治的疾病以泌尿生殖系统疾病居多,其次为肌肉骨骼系统和结缔组织疾病,消化系统疾病、循环系统疾病和呼吸系统疾病分别位居第3、第4和第5位。且以前列腺炎和高血压为常见诊断疾病,其中,前列腺炎是3所医院门诊病人前5种常见诊断疾病之一。②门诊病人选择本单位就诊的原因中前五位分别为医疗技术好(63.0%),慕名而来(30.5%),设备条件好(26.8%),药品丰富(12.9%)和距离近(12.3%)。③2006-2010年住院病人资料显示,3所医院总住院人数以平均6.77%的增长速度逐年上升且住院病人男性多于女性；男性住院患者年龄多分布在45-64岁之间,女性住院患者年龄多分布在25-44岁之间。④对3所医院住院病人疾病谱变化进行分析发现,甲院2006-2010年各年度居前5位的系统疾病顺位为肿瘤、循环系统疾病、影响健康状态和保健机构接触的因素、泌尿生殖系统以及消化系统疾病。其住院病人病历分型主要以A为主。乙院2006-2010年系统疾病以肿瘤居首位,循环系统疾病次之。丙院分型为A的病历所占比例呈逐年下降趋势,而分型为C和D的病历呈现上升趋势。3所医院住院治疗的患者以冠心病和非胰岛素依赖型糖尿病为常见疾病。⑤对3所医院未来5年内住院人次进行预测,预测结果显示,在未来5年内,乙院住院人次将呈平稳上升趋势,而甲院和丙院住院人次将以较快的速度增长。⑥门诊病人地域来源构成分析显示,湖南本地门诊病人24538例,占总被调查人数的87.66%；其次,为江西省1461例,占5.22%；湖北省350例,占1.25%,其中,湖南本地被调查门诊病人以长沙市门诊病人居多,占湖南省被调查门诊病人的25.65%,其次为岳阳市、邵阳市和衡阳市,分别占湖南省被调查门诊病人的11.36%、8.55%和8.28%。2006-2010,3所医院住院病人中,95.63%来自湖南省。来自江西省的住院病人占2.47%,来自广东省的住院病人占0.36%。其中,湖南省本地住院病人以长沙市居多,共计319445人次,占湖南省总住院人次的41.86%；其次为邵阳市61594人次和岳阳市61261人次,分别占8.07%和8.03%。来自其他国家的住院病人共计113例。结论：①门诊调查显示,3所医院以妇产科门诊量居多,神经内科、眼科、皮肤科和耳鼻喉科位居第2、第3、第4和第5。②门诊及住院病人以泌尿生殖系统的疾病居多。前列腺炎和高血压为常见诊断疾病。③医疗技术好成为3所医院门诊病人就诊的主要原因。④2006-2010年各年度居前5位主要系统疾病顺位为肿瘤、循环系统疾病、影响健康状态和保健机构接触的因素、泌尿生殖系统以及消化系统疾病。⑤3所医院门诊及住院的病人几乎覆盖了全国,且地域影响力在华中和西南地区体现的尤为明显。省外住院病人所占比例将呈逐渐增加趋势。⑥基于疾病谱的变化,医院应及时调整医疗专业结构,合理设置科室内部结构,优化医疗卫生资源配置,把握医院工作重心。同时医院管理者应加强对疾病构成变化的关注程度,有序开展其常见病、多发病的防治工作,以提高广大人民群众的健康水平和生命质量。更多还原

【Abstract】 Objectives:To explore patient disease constitutes of three affiliated hospitals and medical service influence by analyzing in-patient and out-patient information, and as well as to realize influence degree resulted from disease. At the same time, to provide scientific evidence for adjusting and configuring the health resources and put forward the effective preventive measures.Methods:Through the self-designed questionnaire, and random sampling method, surveys were carried out in three hospital outpatients. Then using the questionnaire survey results, we calculated some statistical indexes, such as disease species, regional constitution.Using 2006-2010 three hospital in-patient data, comparative analysis was established to analyze hospital patient age, gender and system disease types, and single disease constitutes, and to compare disease constitutes and medical service influence of three different hospitals. Logarithmic transformation was brought to achieve the homogeneity of variance. Apply grey forecasting model to fitting the time series data in three hospitals from 2006 to 2009. Two indicators such as Residual Test and Posterior Test were introduced to assess synthetically the precision of this prediction method. After that, make prediction to the trends in 2010-2015 in advance. All analyses and predictions were performed using SPSS version 17.0 and MATLAB. All of the statistical tests were two sided, and the’significance level’wasα=0.05. Results:(1) The results from outpatient surveys showed that the proportion among women and men were 50.51% and 49.49% respectively, gender ratio was 98.02%. Out-patients in Gynecology were higher, the number of patients in Neurology, Ophthalmology, Dermatology and ENT rank the second, third, fourth and fifth respectively. The ICD-10 system disease outcomes demonstrated that the number of outpatient services related to the genitourinary system disease taken the highest, followed by the musculoskeletal system disease, and connective tissue disease, and digestive system disease, and circulatory diseases and respiratory diseases. And with the prostatitis and high blood pressure as the common diagnose diseases. In addition, prostatitis is one of the most common diseases in three hospital clinic patients.(2) The outpatients choose this hospital mainly in following reasons: medical technology (63.0%), well-known (30.5%), advanced equipment (26.8%), much drugs (12.9%) and distance (12.3%).(3) In-patients data showed that the number of people increased at the rate of 6.77% year by year and among hospitalized patients with men more than women; most male patients aged 45-64 while female patients aged 25-44.(4) By analyzing the changes of the diseases spectrum, it found that the top five system diseases were tumor, circulatory system disease, health status and health institution contact factors, genitourinary system, and the digestive system disease in the first hospital from 2006 to 2010. Its patients ranked A as major medical record classification. The second hospital ranked the tumor as the major disease, followed by circulatory system disease from 2006 to 2010. The medical record classification, A, has been declining year by year in the third hospital. On contrary, the classification of C and D emerging a rising trend. Three hospitals’ patients with the coronary artery disease and the non insulin-dependent diabetes as the common diseases.(5) The predictive results demonstrated the number of in-patients in the second hospital would rise steadily, while the number of in-patients in the first hospital and the third hospital would increase rapidly in the next five years.(6) Local outpatient in Hunan account for 24538, taking the proportion of 87.66%, followed by Jiangxi, accounting for 5.22%, Hubei taking 1.25%. Among the Hunan province, outpatients in Changsha accounts for the majority of 25.65%, Yueyang taken the second place, followed by Shaoyang and Hengyang taking 8.55% and 8.28% respectively.The in-patients with 95.63% came from Hunan province in the three hospitals from 2006 to 2010. Jiangxi and Guangdong account for 2.47% and 0.36%, respectively. Among them, the local patients in Changsha accumulated to 319445 person-times, taking 41.86%; followed by Shaoyang and Yueyang with 61594 and 61261 person-times. Conclusion:(1) Out-patients in Gynecology were higher, the number of patients in Neurology, Ophthalmology, Dermatology and ENT rank the second, third, fourth and fifth respectively.(2) The number of outpatients and inpatients related to the genitourinary system disease taken the highest, Prostatitis and high blood pressure were relatively common diseases.(3) Medical technology as the main reason for outpatients choosing these three hospitals.(4) The top five system diseases were tumor, circulatory system disease, health status and health institution contact factors, genitourinary system, and the digestive system disease from 2006 to 2010.(5) The patients came from throughout the country. And most of patients distribute in the Central and Southwestern of China. The patients coming from other provinces except Hunan will increase gradually in the future. (6) With the spectrum of diseases changed, hospital should adjust medical specialty structure timely, setting up reasonable department internal structures, optimizing the allocation of health resources, grasp the hospital center of gravity. Meanwhile hospital managers should care more about the changes in disease composition; orderly enhance prevention and cure working of common disease and frequently-occurring disease, in order to improve the people’s health and life quality.更多还原