影响心肌梗塞病人住院日的因素及对策分析

【作者】 刘晓梅；

【导师】 苗志敏；

【作者基本信息】 青岛大学 ， 社会医学与卫生事业管理， 2011， 硕士

【摘要】 目的：通过对2007-2010年某院选取外科手术常见的单病种心肌梗塞进行调查,研究影响单病种平均住院日的各种因素,从而提出缩短住院日的可行途径,为公立医院改革提供政策建议。方法：(1)抽样方法：从医院病案室抽取2007年1月1日至2010年1月1日心肌梗塞介入治疗的病人病历共347例,本课题予以全部抽取。费用信息来自住院部收费处。(2)调查方法：1)定量资料：采用病历回顾的方法进行数据收集工作,即从病人的住院病历中收集所有可能影响平均住院日的信息。采用Excel 2007软件录入原始数据,运用SPSS 17.0软件进行统计分析。2)定性资料：采用专家咨询法收集资料,将专家访谈的记录资料作为分析心肌梗塞手术病人住院日的现状、存在问题及非适宜住院日的基础,从而找出各影响因素对住院日的影响。结果：对影响住院天数的各类因素通过单因素方差分析发现：社会学因素中性别、年龄、职业、医保方式、入院季节、住院次数对住院天数有显著影响；疾病因素中病人入院病情、伴随病、医院感染、并发症对住院天数有显著影响；临床因素中确诊天数、特殊检查、入-出院科室、入院诊断、入-出院诊断是否符合、确定手术日期所用时间、主要治疗结果对住院天数有显著影响。对影响住院天数的各类因素通过多元逐步回归分析得出：社会学各因素中按标准化回归系数大小依次为：性别、住院次数、病人年龄、职业。疾病各因素依次为：医院感染、伴随病、并发症。临床各因素依次为：确定手术日期、入-出院科室、入-出院诊断、入院诊断。结论：(1)衡量住院日的指标值发生显著变化(2)结合病种特点确定适宜的平均住院日。(3)创新之处在于在流程上分析不适宜住院日的影响因素更多还原

【Abstract】 Objectives:Choose the common surgical operations of singe-disease of MI(Myocardial Infarction)) from the hospital in Heart department between 2007-2010 to investigate, research all kinds of influence factors on ALOS(Average Length of Stay) of single-disease, find the way and proposals to shorten ALOS of hospital and control the improper medical cost for public hospital reforms.Method:Choose all the 347 records and costs of MI patients who have been intervened therapy method to cure from Record department and In-patients department between 2007-2010.The method of investigating1 Quantitative data: Use the way of record-reviewing to collect data of impacting the ALOS of MI and input the data to Excel table to analysis in SPSS.2)Qualitative data:Through the way of consulting professors to collect data and make it as the base to analyze the realities, problems and improper length of stay of MI patients, and finally find all the influence factors on the ALOS.Results:Through the one-way ANOVA to analyze all kinds of social influence factors and such as follows have a significant impact on the ALOS:The patients’gender,age,employment,the way of medical insurance, the seasons of cure, the number of hospitals; In all kinds of disease factors: patients’individuals,with of illness, hospital infection,complications;In all kinds of clinical influence factors: the day of make diagnosis, special checks, beginning and last department, beginning diagnosis, beginning and last diagnosis if consistent, the time to make the operation, main the cure result.Through the way of linear regression have such results: According to the regression coefficients size in social factors in turn:gender,age,employment;In disease factors: hospital infections, with illness,complications;In the clinical factors: the time to make the operation, beginning and last department, beginning and last diagnosis if consistent, beginning diagnosis have a significant impact on the ALOS.Conclusions:(1) The.statistics of ALOS has obviously change.(2) According to the single-disease’ individuals to make sure the improper ALOS..(3) The innovation is that analyze influence factors on ALOS in the medical process.更多还原