县级医院老年患者不适当入院的决定因素：中国农村的一项横断面研究。
Determinants of inappropriate admission of elderly people in county-level hospitals: a cross-sectional study in rural China.
机构信息
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, China.
出版信息
BMJ Open. 2019 May 1;9(4):e026443. doi: 10.1136/bmjopen-2018-026443.
OBJECTIVE
The purpose of this paper is to investigate the characteristics and determinants of inappropriate admission to hospital of elderly people in rural China.
DESIGN
A cross-sectional study of a comparison between the elderly and non-elderly groups of people.
SETTING
The survey was conducted on the largest county-level general hospitals in four counties in central and western China.
PARTICIPANTS
A total of 652 rural patients admitted in hospitals were surveyed, who were divided into two groups according to age: elderly group (n=230, age ≥60 years) and non-elderly group (n=422, age <60 years).
PRIMARY MEASURES
The Chinese version of the appropriateness evaluation protocol was used to evaluate the inappropriate admission rates. The interactive regression models based on the relationship of age (elderly and non-elderly) with other factors and binary logistic regression models were used in the analysis of the specific factors and determinants of the inappropriate admission of elderly people.
RESULT
The inappropriate admission rate for the rural elderly was 30%, which was lower than that of the non-elderly people (40.8%). Compared with the non-elderly group, women in the elderly group (OR=0.33, 95% CI 0.15 to 0.73) had a lower incidence of inappropriate admission, and elderly people with chronic diseases (OR=3.33, 95% CI 1.23 to 9.04) were more prone to being inappropriately admitted than non-elderly people with chronic diseases. The binary logistic regression analysis shows that county, age (OR=0.94. 95% CI 0.90 to 0.99), gender (OR=0.49, 95% CI 0.25 to 2.98), department and response to doctor's admission request were the determinants of the inappropriate admission of elderly patients.
CONCLUSION
The inappropriate admission rate of elderly people in rural China was high. We found that gender and chronic disease are the specific factors that were specific to non-elderly people. County, age, gender, department and response to a doctor's admission request had substantial influence on the inappropriate admission of the elderly in rural China.
目的
本文旨在研究中国农村老年人不当入院的特征和决定因素。
设计
一项比较农村老年人和非老年人两组人群的横断面研究。
地点
调查在中国中西部四个县最大的县级综合医院进行。
参与者
共调查了 652 名农村住院患者，根据年龄分为两组：老年组（n=230，年龄≥60 岁）和非老年组（n=422，年龄<60 岁）。
主要措施
采用中文版适宜性评价方案评估不适宜入院率。采用基于年龄（老年和非老年）与其他因素关系的交互回归模型和二元逻辑回归模型，分析老年人不适宜入院的具体因素和决定因素。
结果
农村老年人的不当入院率为 30%，低于非老年人（40.8%）。与非老年组相比，老年组女性（OR=0.33，95%CI 0.15 至 0.73）的不当入院发生率较低，患有慢性病的老年人（OR=3.33，95%CI 1.23 至 9.04）比患有慢性病的非老年人更容易被不当入院。二元逻辑回归分析显示，县、年龄（OR=0.94，95%CI 0.90 至 0.99）、性别（OR=0.49，95%CI 0.25 至 2.98）、科室和对医生入院请求的反应是老年人不当入院的决定因素。
结论
中国农村老年人的不当入院率较高。我们发现性别和慢性病是老年人特有的具体因素。县、年龄、性别、科室和对医生入院请求的反应对中国农村老年人的不当入院有实质性影响。
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