2001年至2011年我国东部农村地区急性心肌梗死患者住院时间分析

摘要

Objective To describe the average hospital length of stay (LOS) and its trend and variation in rural areas of eastern China,and to analyze the hospital characteristics associated with LOS.Methods We collected the data of representative in-patients with acute myocardial infarction (AMI) in eastern rural areas in 2001,2006 and 2011 by random sampling.The hospital length of stay and its changing trend were described.Hospitals were divided into tertiles-high,middle,low-based on the median LOS;the characteristics of patients,AMI treatment,as well as outcome were compared across the tertiles of hospitals.The association between the hospital characteristics and LOS was analyzed after adjusting for patient-level characteristics.Results We examined the medical records of 2 361 patients hospitalized with AMI from 32 hospitals in the eastern rural areas.The average LOS were (14.7 ± 10)days in 2001,(12.4 ± 10.1)days in 2006,and (11.9 ± 6.5) days in 2011,decreasing annually (F =15.41,P ＜ 0.001).When looking at the cohort on the three time points (2001,2006,and 2011) with ruling out the factors of complication during hospitalization and the LOS outliers,the average LOS still indicated an trend of decline (F =5.44,P =0.02).However,after adjusting for the differences in patient factors,few marked differences in LOS were found over the years (P =0.89).Across the three tertiles of hospitals,categorized as high,middle and low based on the average LOS,a statistical difference existed in the use rate of statin during hospitalization (P ＜0.05).After adjusting for patient-level characteristics,the hospital characteristics were not significantly associated with the average LOS.Conclusions This study showed a trend of an annual decrease of LOS in patients hospitalized with AMI from the eastern rural areas in China.There is nevertheless still significant room for further improvement.Therefore,it is crucial to effectively advance the standardization for AMI patients of diagnosis and treatment,improve healthcare quality,and reduce patient LOS,which is the very key to enhancing the AMI treatments in the rural region of Eastern China.%目的 了解我国东部农村地区急性心肌梗死(AMI)患者的住院时间及变化趋势,分析与住院时间有关的医院特征.方法 通过随机抽样获取2001、2006、2011年我国东部农村具有代表性的AMI住院患者研究数据,描述住院时间及其变化趋势;按照住院时间的中位数将医院分为高、中、低三类,比较三类医院间患者特征、诊疗模式和院内并发症的差异;分析调整患者水平特征后,医院特征与住院时间的相关性.结果 对32家东部农村地区医院的2 361例AMI住院患者病历进行分析,2001、2006、201 1年的住院时间分别为(14.7±10.0)d、(12.4± 10.1)d和(11.9 ±6.5)d,呈逐年降低的趋势(F=15.41,P＜0.001).排除住院期间并发症和住院时间离群值的人群,3个年份住院时间仍呈降低趋势(F=5.44,P=0.02),调整患者因素差异之后,各年份间住院时间无明显变化趋势(P=0.89).按住院时间划分的高、中、低三类医院间,住院期间他汀的使用率比较差异有统计学意义(P＜0.05).调整患者水平特征后,医院特征与住院时间无明显相关性(P＞0.05).结论 尽管我国东部农村地区AMI患者的住院时间呈现逐年缩短的趋势,但仍有较大的改善空间.因此,有效提高AMI患者的诊疗规范性、医疗质量,缩短住院时间,是改善我国东部农村地区AMI患者诊疗的关键.