重庆市黔江区居民再入院特征分析  

Analysis on the Readmission Characteristics of Residents in Qianjiang District of Chongqing

作　　者：徐源[1,2] 张研[1,2] 刘文俊[1,2] 张亮[1,2] 

机构地区：[1]华中科技大学医药卫生管理学院,武汉430030 [2]湖北省人文社科重点研究基地农村健康服务研究中心,武汉430030

出　　处：《中国卫生经济》2016年第5期64-67,共4页Chinese Health Economics

基　　金：国家自然科学基金项目(71273099)

摘　　要：目的：明确重庆市黔江区居民县域内再入院特别是跨级住院的水平、流向、费用及地域特征,为提升患者再入院服务质量及乡镇卫生院的吸引力提供依据。方法：选取重庆市黔江区2008—2013年的新型农村合作医疗住院数据运用Ex-cel 2010编程技术筛选得到14 395条再入院患者数据。用自体条件匹配技术比较患者跨级县级住院与相应的直接县级住院的费用水平。通过Arc GIS 10.0技术展示再入院患者的地区分布。结果：6年间黔江区再入院的比重基本保持在5%-6%,并逐年上升;再入院患者中县-县住院所占比重最大为40%左右,其次是乡-乡30%左右,乡-县17%左右;越是靠近省道国道的乡镇跨级比重越高,越是接近城区的乡镇县-县再入院路径比重越高,越是边缘的乡镇乡-乡再入院路径比重越高;虽然跨级住院的费用总是高于单次住院的费用水平,但其差异间无统计学意义。结论：患者再入院结构不合理,就医选择较为无序;空间可达性会影响患者再住院路径选择;县乡两级衔接不佳,跨级住院优越性没有得到体现。Objective：To figure out the situation of readmission in Qianjiang, Chongqing City, and the flow, medical cost and geographical features of patients, provide evidence for enhancing the quality of readmission and the attractiveness of township health institutions.Methods：After screening the database of the New Rural Cooperative Medical System（NCMS） by using Excel 2010, it received 14 395 records of readmission inpatients. The matching technique of self-condition was applied to compare the cost level ofmulti-institutional readmission and the relevant direct tounship admission. Arc GIS10.0 was applied to show the regional distributionof readmission patients.Results：The readmission rate in Qianjiang District remained at 5% -6% in 6 years, which gradually increased by years. The rate of county-county, town town and town-county readmission was about 40%, 30% and 17%. The multi-institutional readmission rate of patients lived close to national and provincial highway was higher than that in other area. The county-county readmission rate of patients lived close to urban area is higher while the town- town readmission rate of patients livedaway from urban area was higher. The medical costs of multi-institutional readmission patients were higher than others, but the difference had no statistically significant.Conclusion：The readmission structure was irrational. Residents＇ behavior of visiting doctorwas disarranged. Accessibility would affect the readmission pathway. Town level and county level health institutions were lack of engagement. The advantage of multi-institutional readmission did not reflect.

关 键 词：居民再入院 跨级住院 县域内 重庆 

分 类 号：R197.3[医药卫生—卫生事业管理]