基于AEP的某三级甲等医院5年住院日适当性评价

目的 运用住院日适当性评价方案（AEP）评价某三级甲等医院2009-2013年住院日适当性.方法 抽取2009-2013年间1-5月主要诊断为“肝硬化并伴有消化道静脉曲张出血”的患者病历,运用AEP进行回顾性分析,判断每一个住院日是否适当,并对不适当住院日进行原因和费用分析.结果 回顾472份病历,共计6 297个住院日.其中,942个住院日判断为无效,住院日不适当性比例为14.96％.性别、所在科室、是否节假日或周末、区域、付费方式、入院年份和其他诊断数目对住院日适当性的影响有统计学意义（P＜0.05）.不适当住院日医疗费用共计77.5万元,若能有效控制,平均每患者住院费用可下降l 641.4元,平均住院日可下降1.996天.结论 与国内外相关研究相比,研究的不适当住院日比例处于中低等水平;院内采取综合管理措施,将有助于进一步改善住院日适当性.

Evaluation of the Hospitalization Appropriateness of a Third-Level Hospital in 5 Years Based on AEP

Objective To estimate hospitalization appropriateness of a third-level hospital between 2009 and 2013 through Appropriateness Evaluation Protacol （AEP）.Methods Medical records between January and May during 5 years （between 2009 and 2013） from a third-level hospital in Beijing were abstracted,of which the major diagnosis was Cirrhosis Complicated Hemorrhage Variceal Gastrointestinal Bleeding.A respective study was conducted with AEP to analyze whether a hospital length of stay was appropriate.The fee and causes of the inappropriate hospital day were also anaIvzed.Results 6 297 hospitalization days from 472 medical records were reviewed,of which 942 hospital stays were judged inappropriateness.The inappropriate hospitalization rate is 14.96％.The total cost for inappropriate hospitalization was 775 000 RMB,the mean inappropriate cost per patient was 1 641.4 RMB and the inappropriate length of stay per patient was 1.996 days.Conclusion The inappropriate hospitalization rate is in a middle-and-low level compared with the related records abroad.Better hospitalization appropriateness will be achieved if comprehensive measures are carried out within the hospital.