我国三级医院住院患者死亡率的影响因素分析

摘要

目的：分析国内三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》基线调查中三级医院具有完整的住院患者死亡率和人力资源等数据的医院进行统计分析。结果：国内三级医院总体住院患者死亡率的中位数为0.838%(0.485%〜1.378%)，北部地区的住院患者死亡率高于南部地区(P<0.001)；多元线性回归分析结果显示医护比和住院ICU死亡率与住院患者死亡率正相关，每床出院患者数和每护士出院患者数与住院患者死亡率负相关；医生护士的职称和学历与住院患者死亡率没有关系。结论：国内南部和北部地区住院患者死亡率差异明显；加强ICU建设、增加护士人数、提高医护人员经验和技能也许可以降低住院患者死亡率。%Objective: To identify the influencing factors of inpatient mortality rate in tertiary hospitals in China. Method: Hospitals who have completed mortality rate and human resources data from the Baseline Survey of Healthcare Service Capacity for Chinese Secondary and Tertiary Hospitals were selected and analyzed. Results: The median of the tertiary hospitals in China is 0.838 %( 0.485%-1.378%). The inpatient mortality of tertiary hospitals in north of China was higher than those in south(median 1.040% vs 0.712%, p<0.001). From multilevel regression analysis, It showed (I) Physician-to-nurse ratio and mortality of ICU had a positive correlation with in-hospital mortality. (II) Patients per bed and patients per nurse had a negative correlation with in-hospital mortality. (III) And there was no relations found between in-hospital mortality and professional qualification or education background. Conclusions: Inpatient mortality in tertiary hospitals differs greatly between south and north of China. The construction of ICU, increasing the number of nurses and enriching experience and skill of doctors and nurses can reduce inpatient mortality.