摘要
目的分析某三甲医院双向转诊住院患者特点,了解国家分级诊疗制度在三甲医疗机构实践中的实施效果,为提高转诊效率提供借鉴。方法从某三甲医院2015年1月1日-2019年12月31日电子病历首页和住院病案系统首页记录中提取双向转诊出院患者20364名和直接入院患者281489名的数据记录,通过转诊信息分组分析,将住院病案首页数据导入DRGs管理系统,根据病例组合指数CMI值和患者个人分组汇总数据进行差异分析,找出区别于非上转患者的主要特征。结果双向转诊中上转患者主要来自二级医院(占比>80%)、年龄区间更趋于50岁以上(占比>82%),其疾病分布对医院整体CMI具有显著影响(P<0.05),治疗难度系数更大,住院日更长(P<0.05),手术更多为三四级(P<0.05),疑难病例更多(P<0.05),更多患者具有并发症(P<0.05),医疗费用更高(P<0.05)。结论分级诊疗转诊患者具有显著特点,实行分级诊疗和双向转诊达到了一定的政策实施效果,对国家医疗卫生体制改革成效具有实践意义。
Objectives The characteristics of two-way referral of inpatients in a Three A and Tertiary Hospital were analyzed to understand the implementation effect of the national hierarchical diagnosis and treatment system in the practice of Three A and Tertiary medical institutions, so as to provide reference for improving the efficiency of referral. Methods Data records of 20 364 patients with double referral and discharge and 281 489 patients with direct admission were extracted from the front page of electronic medical records and the front page of inpatient medical record system of a Three A and Tertiary Hospital from January 1 st, 2015 to December 31 st, 2019. By grouping analysis of referral information, the front page data of inpatient medical records were imported into the DRGS management system. Differences were analyzed based on the CMI value of the case portfolio index and the patient’s individual grouped summary data to find out the main characteristics that distinguished the patients from the non-up-transfer patients. Results The patients in two-way referral were mainly from secondary hospitals(accounting for more than 80%), and the age range tended to be more than 50 years old(accounting for more than 82%). The disease distribution had a significant impact on the overall CMI of the hospital(P<0.05), with greater difficulty of treatment, longer hospitalization days(P<0.05), and more surgeries were performed in Grade Ⅲ or Ⅳ(P<0.05). There were more difficult cases(P<0.05), more patients had complications(P<0.05), and the medical costs were higher(P < 0.05). Conclusions Graduated diagnosis and treatment had significant characteristics of patients with referral. The implementation of graded diagnosis and treatment and two-way referral had achieved certain policy implementation effect, which had practical significance for the reform of national medical and health system.
作者
庞宇
成柠
杨旭飙
杨建南
柳华
Pang Yu;Cheng Ning;Yang XuBiao;Yang JianNan;Liu Hua(The 3rd People’s Hospital of Chengdu,Chengdu 610031,Sichuan Province,China;不详)
出处
《中国病案》
2021年第7期67-70,共4页
Chinese Medical Record
基金
四川省卫健委重点项目(19ZD001)。
关键词
分级诊疗
双向转诊
DRGs分组
CMI
Hierarchical diagnosis and treatment
Two-way referral
DRGs grouping
CMI
