山西省慢性病患者住院服务利用现状及影响因素研究

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=...

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

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 stata16.0. 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 from 13.63% in 2013 to 18.77% in 2018. The proportion of inpatient treatment in county-level hospitals was 53.88% in 2013 and 57.77% 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 primary medical institutions, improve the overall planning of chronic disease outpatient service, pay attention to health education, improve the health literacy of residents, and explore the establishment a multi-chronic disease management mode featuring “doctor-patient sharing decision-making centered with patient”.