某妇幼保健院DRGs实施前后非医嘱离院情况分析  

Analysis of non-doctoral discharge before and after the implementation of DRGs in a maternal and child health hospital

作　　者：黄凤[1] 刘伟武[1] 杨镓蔚 李冠林[1] HUANG Feng;LIU Weiwu;YANG Jiawei;LI Guanlin(Department of Information,Yulin Maternal and Child Health Hospital,Guangxi Zhuang Autonomous Region,Yulin 537000,China)

机构地区：[1]广西壮族自治区玉林市妇幼保健院信息科,广西玉林537000

出　　处：《妇儿健康导刊》2022年第5期113-118,共6页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

摘　　要：目的对某妇幼保健院实施DRGs前后的非医嘱离院情况进行统计分析,分析非医嘱离院患者的分布规律、变化趋势和疾病构成,为降低非医嘱离院发生率,减少负面影响和提高医疗服务水平提供参考。方法提取某妇幼保健院病案管理信息系统2020年1月至6月和2021年1月至6月共22388例出院患者的住院信息,按照ICD-10疾病分类,对非医嘱离院患者的例数、来源、性别、出院科别、年龄及主要诊断等数据运用SPSS 26.0进行统计分析。结果DRGs实施后,某妇幼保健院非医嘱离院总体发生率、出院科别分布、性别比及年龄分布均无明显变化,非医嘱离院平均发生率为4.96%,以儿科和新生儿科出院患者为主,男性多于女性,平均男女性别比为1.40∶1,5岁以下患者非医嘱离院发生率最高,5岁以下患者平均发生率14.86%;DRGs实施后,市外患者和新生儿科的非医嘱离院发生率有上升趋势;DRGs实施前后,非医嘱离院患者的前十位病种中第一顺位病种均为J18(肺炎,病原体未特指),其他顺位病种有不同程度变化,前十位病种中发生率下降的有6个病种,降幅为1.4~8.1个百分点,而发生率上升的有4个病种,增幅为0.1~8.5个百分点。结论某妇幼保健院的非医嘱离院总体发生率未因DRGs的实施发生明显变化,非医嘱离院患者以儿科和新生儿科出院患者为主,主要集中在5岁以下儿童,根据非医嘱离院患者主要诊断疾病谱特点,应加强儿童肺炎、儿童胃肠道疾病、早产低体重儿、新生儿肺炎、新生儿黄疸、新生儿呼吸窘迫、不明原因惊厥等疾病的诊治工作,提高诊疗技术,提升服务质量,进一步降低非医嘱离院的发生率及其带来的负面影响。Objective To make a statistical analysis on the situation of non-doctoral discharge before and after DRGs implementation in a maternal and child health hospital,and to analyze the distribution law,change trend and disease composition of patients leaving hospital without doctor’s orders,so as to provide reference for reducing the incidence of non-doctoral discharge,reducing negative impact and improving medical service level.Methods The hospitalization information of a total of 22388 discharged patients in the case management information system of a maternal and child health hospital from January to June 2020 and January to June 2021 was extracted,according to ICD-10 disease classification,SPSS 26.0 was used to make statistical analysis on the number,source,gender,discharge department,age and main diagnosis of the discharged patients.Results After the implementation of DRGs,there were no obvious changes in the overall incidence of non-doctoral discharge,the distribution of discharged departments,gender ratio and age distribution.The average incidence of non-doctoral discharge was 4.96%,mainly in pediatric and neonatal departments,with more men than women,with an average gender,ratio of 1.40∶1.The highest incidence of non-doctoral discharge was among patients under 5 years old,with an average incidence of 14.86%.After the implementation of DRGs,the incidence of non-doctoral discharge of patients and neonatology departments outside the city had an upward trend.Before and after the implementation of DRGs,among the top ten diseases of patients leaving hospital without doctor’s advice,the first disease was J18(pneumonia,pathogen was not specified),and other diseases changed in different degree.Among the top ten diseases,there were 6 diseases whose incidence decreased by 1.4-8.1 percentage points,while 4 diseases whose incidence increased by 0.1-8.5 percentage points.Conclusion The overall incidence of non-doctoral discharge in a maternal and child health hospital has not changed significantly due to the implement

关 键 词：非医嘱离院 DRGS 医疗服务质量 负面影响 

分 类 号：R197.5[医药卫生—卫生事业管理]