基于回归模型的病历完整性影响因素分析  

Analysis of Influencing Factors of Medical Record Integrity Based on Regression Model

作　　者：任月荣 刘辰龙[1] 王平[2] REN Yuerong;LIU Chenlong;WANG Ping(Department of Medical Records,Peking University First Hospital,Beijing 100034,China;Medical Affairs DEPT,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院病案统计编目室,北京100034 [2]北京大学第一医院医务处,北京100034

出　　处：《中国卫生标准管理》2020年第23期33-36,共4页China Health Standard Management

基　　金：北京大学第一医院科研种子基金(2019SF63)。

摘　　要：目的找出病历后滞单页主要影响因素,兼顾病历的完整性和时效性。方法采用双向队列研究方法,采集北京市某三甲医院10个科别2018年5月—2020年5月的后滞单页和回收率数据,以后滞单页总数为因变量,影响因素科别、病房负责归档人员类型、出院人数和48 h回收率为自变量,建立多元线性回归模型,进行相关性检验和多元线性回归分析,找出影响病历后滞单页产生的主要因素,并对后滞单页数进行预测。结果科别、病房负责归档人员类型、出院人数是影响后滞单页数的主要因素。结论根据各影响因素对后滞单页产生的影响,提出改革建议。为合理调配和优化医疗资源提供具有统计学意义的数据支持,为增强病历完整性、减少后滞单页内容提供参考。Objective To find out the main influencing factors of lagging single page of medical record,taking into account the integrity and timeliness of medical record.Methods Two-way cohort study was used to collect lag sheet and recovery rate data from 10 departments of a thirdclass A hospital in Beijing from May 2018 to May 2020.The total number of lag sheets was a dependent variable,and the influencing factors such as the department,the type of person in charge of archiving in the ward,the number of discharges and 48 h recovery rate were independent variables.A multiple linear regression model was established,and correlation test and multiple linear regression analysis were conducted to find out the influencing factors on the medical records.The main factors of lagging single page generation and the number of lagging single page were predicted.Results Departments,types of archivists in charge of wards,and number of discharges were the main factors affecting the number of single pages of delays.Conclusion According to the influence of various factors on the single page lag,the reform suggestions are put forward.To provide statistically significant data support for rational allocation and optimization of medical resources,and to provide reference for enhancing the integrity of medical records and reducing the content of single page lag.

关 键 词：病历完整性 病历后滞页 DRGS 影响因素 多元线性回归 资源调配 

分 类 号：R197[医药卫生—卫生事业管理]