李佳　盖冬　刘颖　郝亚杰

[摘要] 目的 分析某三甲医院呼吸内科患者住院超过30 d的原因，探索降低平均住院日方法，优化医疗资源配置。方法 采集某三甲医院呼吸内科2015年1月—2018年12月住院超过30 d患者信息，通过统计学方法分析患者住院時间长原因及构成比，找到影响平均住院日的因素。结果 呼吸内科住院超过30 d患者中年龄在60岁以上、原发疾病复杂、医保付费的患者占比最高。结论 疾病因素、患者一般状况、付费方式等独立因素对患者住院时间影响较为明显，可通过落实分级诊疗、加强临床路径管理、提升专业技术水平等方式缩短平均住院日。

[关键词] 住院时间;平均住院日;呼吸内科;影响因素

[中图分类号] R197 [文献标识码] A [文章编号] 1672-5654（2020）07（b）-0057-03

Analysis of Root Causes of Long Hospitalization of Respiratory Medicine Patients Based on Independent Factors

LI Jia， GAO Dong， LIU Ying， HAO Ya-jie

Chifeng City Hospital， Chifeng， Inner Mongolia Autonomous Region， 024000 China

[Abstract] Objective To analyze the reasons why patients in the Department of Respiratory Medicine of a tertiary hospital were hospitalized for more than 30 days， explore ways to reduce the average length of stay， and optimize the allocation of medical resources. Methods Collect the information of patients who were hospitalized for more than 30 days from January 2015 to December 2018 in the Department of Respiratory Medicine of a tertiary hospital， analyze the reasons for the long hospital stay and the composition ratio of the patients through statistical methods， and find the factors that affect the average hospital stay. Results Patients in the Department of Respiratory Medicine who were hospitalized for more than 30 days accounted for the highest proportion of patients over 60 years of age with complicated primary diseases and paid for medical insurance. Conclusion Independent factors such as disease factors， general conditions of patients， and payment methods have a significant impact on the length of hospital stay. The average length of stay can be shortened by implementing hierarchical diagnosis and treatment， strengthening clinical path management， and improving professional skills.

[Key words] Length of stay; Average length of stay; Respiratory medicine; Influencing factors

作为现代公立医院管理指标之一，平均住院日反映着医疗效率管理和医院综合服务水平[1]。基于国内众多医院“看病难”“一床难求”现状，科学合理的床位资源调配是各家医院亟需落实的工作。超长住院时间是影响平均住院日的重要指标，而平均住院日数据是医院能否提升医疗工作效率的主要考核指标，在管理患者住院费用、改进工作效率、增加经济效益等方面的作用不容忽视。有研究提示，随着住院时间的延长，医疗资源的边际效用越来越低[2]。为合理配置医疗资源，提高医疗工作效率[3]，提升患者就医满意度，保障医疗安全，采集某三甲医院呼吸内科2015年1月—2018年12月住院超过30 d的308例患者信息，通过有效方法加强住院超过30 d患者的管理，分析影响住院日的有效因素，提出针对性整改策略，实现降低平均住院日的目标，持续改进医疗质量。……