老年患者超长时间住院现状调查及防控对策建议

背景　老年患者身体功能衰退及老年疾病特点导致的超长时间住院对三级医疗机构的急症病床资源造成了巨大压力。在目前医疗资源紧缺的环境下，研究老年患者超长时间住院的特征，对促进资源合理分配，提高医疗资源有效利用率，提高老年人对医疗服务满意度有重要意义。目的　对超长时间住院的老年患者进行现状调查，分析其特征及影响住院时间的因素，为制定缩短老年患者住院时间防控措施提供依据。方法　采用回顾性调查病例的方法，选取四川省崇州市人民医院2016-2018年住院时间超过30 d的60岁及以上老年患者共计686例的病案首页信息，分析超长时间住院老年患者的特征；采用多元线性回归分析寻找影响超长时间住院老年患者住院时间的因素。结果　686例超长时间住院老年患者占全院同期出院患者0.66%（686/104 068），总住院时间为32 982 d，占全院总住院时间的3.74%（32 982/881 872）。住院时间以31~39 d为主〔343例（50.0%）〕，主要分布在康复科〔293例（42.7%）〕，所患疾病首位为循环系统疾病〔247例（36.0%）〕，合并症个数平均为（7.7±3.4）个，合并症累及系统个数平均为（4.5±1.7）个，改良老年疾病累计评分表（MCIRS-G）评分平均为（24.8±4.0）分，慢病患病率为95.6%（656/686），慢病数目平均（5.4±2.9）个，慢病首位为高血压〔515例（75.1%）〕。多元线性回归分析结果显示，年龄（β=-5.057）、抢救次数（β=2.675）、是否发生院内感染（β=4.245）和MCIRS-G评分（β=5.389）是影响住院时间长短的重要因素（P<0.05）。结论　影响老年患者超长住院时间的因素有：年龄、抢救次数、院内感染、共病负担。构建“医养结合”服务照护体系；发展多学科协作诊疗和照护模式；加强老年重点病种管理；重视老年医学学科的发展，提高医院老年疾病诊治能力可缩短老年患者平均住院日。

Over Prolonged Hospitalization in Elderly Patients：Status Analysis and Prevention and Control Recommendations Based on a Survey

Background　Over prolonged hospitalization in elderly patients due to physical decline and characteristics of geriatric diseases has put great pressure on the resources of emergency beds in tertiary medical institutions.Under the current situation of shortage of medical resources，studying the status of over prolonged hospitalization in elderly patients is of great significance to promote the rational allocation of resources，and improve the effective utilization of medical resources as well as the elderly's satisfaction with medical services.Objective　To analyze the status and influencing factors of over prolonged hospitalization in elderly patients based on a survey，to provide evidence-based data for formulating prevention and control measures to shorten the length of hospitalization in this group.Methods　A retrospective design was adopted.By checking the information on the medical records homepage，data of 686 elderly patients（≥ 60 years） who hospitalized for more than 30 days during 2016 to 2018 in Chongzhou People's Hospital were collected and analyzed.Multiple linear regression analysis was used to identify the factors affecting the length of hospitalization in these patients.Results　During the period，these participants accounted for 0.66%（686/104 068） of the total cases discharged from the hospital，with hospitalized days accounting for 3.74%（32 982/881 872） of the total.Most of the participants〔343 cases（50.0%）〕hospitalized for 31 to 39 days，mainly in rehabilitation department 〔293 cases（42.7%）〕，with circulatory system disease as the most common disease〔247 cases（36.0%）〕，（7.7±3.4） complications on average，（4.5±1.7） systems affected by complications on average，mean MCIRS-G score of（24.8±4.0），chronic disease prevalence of 95.6%（656/686），（5.4±2.9） chronic diseases on average，and hypertension as the most common chronic disease〔515 cases（75.1%）〕.The results of multiple linear regression analysis showed that age（β=-5.057），rescue times（β=2.675），nosocomial infection（β=4.245） and MCIRS-G score（β=5.389） were important factors affecting the length of stay（P<0.05）.Conclusion　The factors influencing the length of stay in elderly patients include age，times of rescue，nosocomial infection and comorbidity burden.To shorten the length of stay in these patients，recommendations are put forward as follows:Constructing an integrated medical and nursing care system，developing the multidisciplinary collaborative diagnostic and therapeutic and care，strengthening the management of key geriatric diseases，attaching great importance to the development of geriatric medicine and improving hospital-based management of geriatric diseases.