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中国不同等级医院分类对患者医疗结局的影响。

The Different Classification of Hospitals Impact on Medical Outcomes of Patients in China.

机构信息

School of Labor and Human Resources, Renmin University of China, Beijing, China.

Research Office of Medical and Care Insurance, Chinese Academy of Labour and Social Security, Beijing, China.

出版信息

Front Public Health. 2022 Jul 18;10:855323. doi: 10.3389/fpubh.2022.855323. eCollection 2022.

Abstract

BACKGROUND

In China, different classification of hospitals (COH) provide treatment for patients with different degrees of illness. COH play an important role in Chinese medical outcomes, but there is a lack of quantitative description of how much impact the results have. The objective of this study is to examine the correlation between COH on medical outcomes with the hope of providing insights into appropriate care and resource allocation.

METHODS

From the perspective of the COH framework, using the Urban Employee Basic Medical Insurance (UEBMI) data of Chengdu City from 2011 to 2015, with a sample size of 512,658 hospitalized patients, this study used the nested multinomial logit model (NMNL) to estimate the impact of COH on the medical outcomes.

RESULTS

The patients were mainly elderly, with an average age of 66.28 years old. The average length of stay was 9.61 days. The female and male gender were split evenly. A high level of hospitals is positively and significantly associated with the death and transfer rates ( < 0.001), which may be related to more severe illness among patients in high COH.

CONCLUSION

The COH made a difference in the medical outcomes significantly. COH should be reasonably selected according to disease types to achieve the optimal medical outcome. So, China should promote the construction of a tiered delivery system.

摘要

背景

在中国,不同级别的医院(COH)为不同病情程度的患者提供治疗。COH 在中国的医疗结果中发挥着重要作用,但缺乏对其结果影响程度的定量描述。本研究旨在探讨 COH 对医疗结果的影响,以期为合理的护理和资源配置提供参考。

方法

本研究从 COH 框架的角度出发,利用成都市 2011 年至 2015 年的城镇职工基本医疗保险(UEBMI)数据,对 512658 名住院患者进行样本分析,采用嵌套多项逻辑回归模型(NMNL)来估计 COH 对医疗结果的影响。

结果

患者主要为老年人,平均年龄为 66.28 岁。平均住院天数为 9.61 天。男女比例均衡。高水平的医院与死亡率和转院率呈正相关且具有统计学意义(<0.001),这可能与高水平 COH 中的患者病情更为严重有关。

结论

COH 对医疗结果有显著影响。应根据疾病类型合理选择 COH,以达到最佳的医疗效果。因此,中国应促进分级诊疗体系的建设。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/44ba/9339675/36d4c79d5c4e/fpubh-10-855323-g0001.jpg

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