山西省慢性病患者住院服务利用现状及影响因素研究  

Study on the utilization status and influencing factors of inpatient services for patients with chronic diseases in Shanxi Province

作　　者：胡安霞 闫娟娟 裴中阳 HU An-xia;YAN Juan-juan;PEI Zhong-yang(School of Health Services and Management,Shanxi University of Traditional Chinese Medicine,Jinzhong,Shanxi 030619,China)

机构地区：[1]山西中医药大学健康服务与管理学院,山西晋中030619

出　　处：《现代预防医学》2023年第3期495-500,516,共7页Modern Preventive Medicine

基　　金：山西省哲学社会科学规划课题(2021YJ058);山西省省筹资金资助回国留学项目(HGKY2019091);山西省教育厅重点人文社科基地项目(20200130)。

摘　　要：目的 了解2013与2018年山西省慢性病患者住院服务利用差异及住院服务利用的影响因素,为完善慢性病管理政策提供依据。方法 利用2013、2018年山西省第五、六次卫生服务调查慢性病患者数据,运用stata 16.0进行统计检验,组间比较采用χ2检验或t检验、住院影响因素分析采用logistic回归,住院床日的影响因素分析采用负二项回归。结果 慢性病患者住院率由2013年的13.63%上升为2018年的18.77%;2013和2018年在县级医院进行住院治疗占比分别为53.88%和57.77%;过去一年需住院未住院原因主要是经济困难;第六次卫生服务调查的次均住院费用为10 266.97元,高于第五次调查的次均住院费用(6 933.91元);饮酒(OR=1.355,95%CI:1.279~1.436)和患慢性病数(OR=1.701,95%CI:1.435~2.017)是住院服务利用的危险因素(P<0.05)。城市(RR=0.833,95%CI:0.714~0.971)、体育锻炼(≥3次/周)(RR=0.884,95%CI:0.799~0.979)、体检(RR=0.876,95%CI:0.791~0.971)可以有效抑制住院床日的增加(P<0.05);离婚丧偶(RR=1.403,95%CI:1.056~1.865)、饮酒(RR=1.193,95%CI:0.996~1.428)、患慢性病数(RR=1.066,95%CI:1.007~1.130)是住院床日增加的危险因素(P<0.05)。结论 山西省慢性病患者住院服务利用率逐年上升,多种因素影响住院服务利用和住院床日,应加强基层医疗机构慢性病管理服务能力,完善慢性病门诊统筹,注重健康宣教,提升居民健康素养,探索建立“以患者为中心,医患共享决策”的多重慢性病管理模式。Objective To understand the difference of inpatient service utilization and influencing factors between 2013 and 2018 in Shanxi Province, to provide basis for improving the management policy of chronic diseases. Methods The data of patients with chronic diseases in the fifth and sixth health service survey of Shanxi Province in 2013 and 2018 were used for statistical test with the use of stata 16.0. Chi-square test or t test was used for comparison between groups, logistic regression was used for analysis of influencing factors of hospitalization, and negative binomial regression was used for analysis of influencing factors of hospitalization bed days. Results The hospitalization rate of chronic disease patients increased from13.63% in 2013 to 18.77% in 2018. The proportion of inpatient treatment in county-level hospitals was 53.88% in 2013 and57.77% in 2018, respectively. Financial difficulty was the main reason for not being hospitalized when needed in the past year. The average hospitalization cost of the sixth health service survey(10 266.97 yuan) was higher than that of the fifth survey(6 933.91 yuan). Alcohol consumption(OR=1.355, 95%CI: 1.279-1.436) and multiple chronic diseases(OR=1.701,95%CI: 1.435-2.017) were risk factors for inpatient service utilization(P<0.05). Urban residence(RR=0.833, 95%CI: 0.714-0.971), exercise(RR =0.884, 95% CI: 0.799-0.979), and physical examination(RR =0.876, 95% CI: 0.791-0.971) could effectively inhibit the increase of hospitalization bed days(P<0.05). Divorce and widowed spouse(RR=1.403, 95%CI: 1.056-1.865), alcohol consumption(RR=1.193, 95%CI: 0.996-1.428), and multiple chronic diseases(RR=1.066, 95%CI: 1.007-1.130) were the risk factors for increased hospitalization days(P<0.05). Conclusion The utilization rate of inpatient services for chronic diseases in Shanxi Province is increasing year by year, and multiple factors affect the utilization of inpatient services and inpatient bed days. It is necessary to strengthen the chronic disease management and service ability of

关 键 词：山西 慢性病患者 住院服务利用 

分 类 号：R197.1[医药卫生—卫生事业管理]