Liu Wenwei, Yuan Suwei, Wei Fengqing, Yang Jing, Zhu Changbin, Yu Y, Ma Jin
School of Philosophy, Law and Political Science, Shanghai Normal University, No. 100 Guilin Road, Shanghai 200234, China.
School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chong Qing Road, Shanghai 200025, China.
Int J Qual Health Care. 2017 Oct 1;29(5):699-704. doi: 10.1093/intqhc/mzx091.
This study aims to evaluate the prevalence of inappropriate hospital stays in a tertiary hospital in Shanghai, identify the causes for the inappropriateness and analyze the predictors.
A retrospective review of medical records.
The cardiology and the orthopedics departments of a tertiary hospital in Shanghai, China.
About 806 patients discharged from the cardiology or the orthopedics department of a tertiary hospital from March 2013 to February 2014.
Two reviewers audited 8396 hospital days of the cardiology department (n = 3606) and the orthopedics department (n = 4790) by adopting the Chinese Version of the Appropriateness Evaluation Protocol. Univariate and multivariate analysis were adopted to identify the predictors of higher levels of inappropriateness produced by internal causes.
The prevalence of inappropriate hospital days.
It was found that 910 (25.2%) and 1940 (40.5%) hospital days were judged to be inappropriate in the cardiology and the orthopedics departments, respectively; and 753 (20.9%) and 1585 (33.1%) of these inappropriate hospital days were due to internal reasons, respectively. Awaiting tests, surgery or discharge were determined to constitute the main causes of inappropriateness for both departments. The predictors of higher levels of inappropriateness in the cardiology department were younger age, self-pay, outpatient admission and inappropriate admission. Self-pay, surgical and/or first-time admission patients exhibited the highest levels of inappropriateness in the orthopedics department.
The rates of inappropriateness in the involved departments were relatively high. Further interventions should be designed and implemented, accordingly.
本研究旨在评估上海某三级医院不适当住院的发生率，确定不适当的原因并分析预测因素。
对病历进行回顾性研究。
中国上海某三级医院的心脏科和骨科。
2013年3月至2014年2月期间从某三级医院心脏科或骨科出院的约806名患者。
两名审查员采用中文版的适当性评估方案，对心脏科（n = 3606）和骨科（n = 4790）的8396个住院日进行了审核。采用单因素和多因素分析来确定内部原因导致的较高不适当水平的预测因素。
不适当住院日的发生率。
发现心脏科和骨科分别有910个（25.2%）和1940个（40.5%）住院日被判定为不适当；其中，这些不适当住院日分别有753个（20.9%）和1585个（33.1%）是由于内部原因。等待检查、手术或出院被确定为两个科室不适当的主要原因。心脏科较高不适当水平的预测因素是年龄较小、自费、门诊入院和不适当入院。自费、手术和/或首次入院的患者在骨科表现出最高水平的不适当。
相关科室的不适当率相对较高。因此，应相应地设计和实施进一步的干预措施。
