Lei Shi-Han, Zhang Yan, Li Hao-Miao, Su Dai, Chang Jing-Jing, Hu Xiao-Mei, Ye Qing, Jiang Di, Chen Ying-Chun
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030, Hubei, China.
BMC Health Serv Res. 2019 Feb 18;19(1):126. doi: 10.1186/s12913-019-3944-1.
The incidence of inappropriate admissions in China has become the shackle of its' service supply system. This research aims to assess the level of children's inappropriate admissions to county hospitals in rural China and identify the characteristics and determinants of children's inappropriate admissions.
A retrospective review was conducted on data of children aged 0-14 years. A total of 771 children medical records in four county hospitals was collected by stratified random sampling in Midwestern China and was evaluated through the Rural Appropriateness Evaluation Protocol. A questionnaire survey was conducted among doctors whose names were shown in medical records. Chi-square test was used to analyse the characteristics of inappropriate admissions, and a binary logistic regression model was used to examine the determinants of inappropriate admissions.
Inappropriate admissions indicate that patients who could have been treated as outpatients received services as inpatients. The average rate for inappropriate admissions of children in county hospitals was 61.35%. The highest rate of inappropriate admissions was found among children aged 1-5 years (68.42%). Inappropriate admissions mostly occurred in children with respiratory diseases (72.45%), circulatory diseases (72.22%) and certain infectious diseases and parasitic diseases (70.37%). Binary logistic regression analysis showed that county, normal health status, treating department, disease, the length of hospital stay and the doctor's self-evaluation on the understanding about the degree of the patient's feelings were determinants for children's inappropriate admissions.
County hospitals have a high rate of inappropriate admissions of children. The relationship of children's inappropriate admissions to age distribution and the insurance compensation is affected by disease and hospitalisation expenses, respectively. The determinants of children's inappropriate admissions are directly related to the weak level of primary care services in the health service system, the initial requirements requested by children's admission decision makers and the interests among medical institutions and doctors.
中国不适当入院的发生率已成为其服务供应体系的桎梏。本研究旨在评估中国农村县级医院儿童不适当入院的水平，并确定儿童不适当入院的特征和决定因素。
对0至14岁儿童的数据进行回顾性研究。通过在中国中西部地区进行分层随机抽样，收集了四家县级医院的771份儿童病历，并通过农村适宜性评估方案进行评估。对病历中显示姓名的医生进行问卷调查。采用卡方检验分析不适当入院的特征，并使用二元逻辑回归模型检验不适当入院的决定因素。
不适当入院是指那些本可作为门诊患者治疗的患者却接受了住院服务。县级医院儿童不适当入院的平均发生率为61.35%。1至5岁儿童的不适当入院率最高（68.42%）。不适当入院大多发生在患有呼吸系统疾病（72.45%）、循环系统疾病（72.22%）以及某些传染病和寄生虫病（70.37%）的儿童中。二元逻辑回归分析表明，县、健康状况正常、治疗科室、疾病、住院时间以及医生对患者感受程度理解的自我评估是儿童不适当入院的决定因素。
县级医院儿童不适当入院率较高。儿童不适当入院与年龄分布以及医保补偿的关系分别受疾病和住院费用的影响。儿童不适当入院的决定因素与卫生服务体系中基层医疗服务水平薄弱、儿童入院决策者的初始要求以及医疗机构和医生之间的利益直接相关。
