我国二级医院住院患者死亡率的影响因素分析

摘要

目的:分析国内二级医院住院患者死亡率的影响因素.方法:选取《中国二三级医院医疗服务能力》基线调查中二级医院中具有完整的死亡率、医生护士数据和运行指标的医院进行分析.结果:国内二级医院总体住院患者死亡率的中位数(四分位间距)为0.386％(0.192％～0.893％).不同地区和医院类型间住院患者死亡率无差异.护士人均患者数每增加1人,住院患者死亡率高的可能性降低1.8％;平均住院日每增加1天,住院患者死亡率高的可能性增加9.7％.护士的学历与住院患者死亡率无关.结论:护士的临床护理经验对降低住院患者死亡率具有重要作用,医生的高学历可能不能代表较高的医疗水平,患者的病情严重程度是决定住院患者死亡率的最主要因素.实施医护人员的临床技能培训或派遣医护人员到三级医院进修是二级医院提高医疗水平降低住院患者死亡率的有效手段.%Objective:To analyze the influencing factors of inpatient mortality on secondary hospitals in China.Method:Secondary hospitals that have complete data of mortality rate,the numbers of doctors and nurses and financial indictors in the Baseline Survey of Healthcare Service Capacity for Chinese Secondary and Tertiary Hospitals were selected aud analyzed.Result:The median (Q25-Q75) of the secondary hospitals in China is 0.386％(0.192％-0.893％).There is no significant difference among different districts and types.The probability of high mortality impatient will decrease 1.8％ when patients per nurse increase 1.When average length of stay increases 1 day,the probability of inpatient mortality will increases 9.7％.And there is no correlations found between inpatient mortality and educational level of nurses.Conclusion:The clinic experience of nurses can significantly decrease inpatient mortality.High education levels for doctors may not stand for high clinical level.The severity of patient disease is the most important factor determining mortality.Carrying out clinical skill training or further education in tertiary hospitals for doctors and nurses are the effective methods to decrease inpatient mortality of secondary hospitals.