中国上海一家二级医院儿童住院不适宜性及其相关因素的流行状况。

Prevalence and associated factors of inappropriate hospital admissions and days of children in a secondary hospital in Shanghai, China.

机构信息

College of Philosophy, Law and Political Science, Shanghai Normal University, Shanghai, China.

School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.

出版信息

PLoS One. 2022 Oct 6;17(10):e0275645. doi: 10.1371/journal.pone.0275645. eCollection 2022.

DOI:10.1371/journal.pone.0275645

PMID:36201444

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9536573/

Abstract

BACKGROUND

Although the appropriateness of hospital utilization of adults and the elderly in China was audited by several studies, the appropriateness of hospital use by children in Shanghai remains to be determined. This study aims to assess the level of inappropriate hospital admissions and hospital days, to detect factors associated with inappropriateness, and to elucidate reasons for inappropriateness.

METHODS

A retrospective review of the records of 291 admissions and 1449 hospital days of children inpatients from a secondary hospital in Shanghai was performed by two reviewers using the Chinese version Pediatric Appropriateness Evaluation Protocol (C-PAEP). Demographics, socio-economic characteristics, and other admission- or hospital stay-related information were collected and analyzed to determine factors associated with inappropriateness utilizing multivariate regression models.

RESULTS

38.5% (n = 112) of admissions and 9.5% (n = 137) of hospital days were categorized as inappropriate, according to the C-PAEP. Children who were non-Shanghai residents (p < 0.001), admitted through the emergency sector (p = 0.030), and/or received services in a surgical ward (p < 0.001) had a higher risk of being admitted inappropriately. Payment method (p = 0.006), service type (p < 0.001), comorbidity (p = 0.016), length of stay (p = 0.007), and appropriateness of admission (p < 0.001) were found to be associated with prevalence of inappropriate hospital days. Approximately three-fourths of the inappropriate admissions were premature admissions (75.9%, n = 85). The most frequent reasons for inappropriate hospital days were awaiting test results (34.3%, n = 47), awaiting surgery (19.7%, n = 27), awaiting test execution (10.9%, n = 15), and family unprepared for home care (10.9%, n = 15).

CONCLUSIONS

Although the extent of inappropriate hospital days was moderate compared with that found by previous investigations, the prevalence of inappropriateness of admission was considerable. To enhance the appropriateness of hospital care for children, interventions could be implemented according to the associated factors and identified causes.

摘要

背景

尽管已有多项研究对中国成人和老年人住院的适宜性进行了审核，但上海儿童住院的适宜性仍有待确定。本研究旨在评估儿童住院的不适宜性入院和住院天数水平，发现与不适宜性相关的因素，并阐明不适宜性的原因。

方法

对上海某二级医院 291 例住院患儿的住院记录进行回顾性审查，由两位审核员使用中文版儿科适宜性评价方案（C-PAEP）进行。收集并分析人口统计学、社会经济特征和其他与入院或住院相关的信息，以利用多变量回归模型确定与不适宜性相关的因素。

结果

根据 C-PAEP，38.5%（n=112）的入院和 9.5%（n=137）的住院天数被归类为不适宜。非上海户籍患儿（p＜0.001）、通过急诊入院（p=0.030）和/或在外科病房接受服务的患儿（p＜0.001）入院不适宜的风险更高。支付方式（p=0.006）、服务类型（p＜0.001）、合并症（p=0.016）、住院时间（p=0.007）和入院适宜性（p＜0.001）与住院天数不适宜的发生率相关。大约四分之三的不适宜入院为过早入院（75.9%，n=85）。住院天数不适宜的最常见原因是等待检查结果（34.3%，n=47）、等待手术（19.7%，n=27）、等待检查执行（10.9%，n=15）和家庭对居家护理准备不足（10.9%，n=15）。