Analysis Of Diseases Of Inpatients In A Community In Shanghai And Investigation On The Current Situation Of Inpatients In Two Cities In Suburbs

ObjectiveTrough analysis hospital disease of a community heath centre, and prevalence survey to inpatients of two community heath centre’s ward in suburban, to understand the basic situation of the Community hospitalized patients and cause of long-term hospitalization, and the difference between city and suburbs. On the one hand, to provide baseline data for the management of community ward and the general practitioner future focus and direction; On the other hand, in order to be able to find the reason of supply and demand of community ward and the ways to solve the question.MethodsThe subject is divided into two parts. Part I:we need to collect all patients data from2010.1.1to2011.12.31of the Kangjian community heath centre’ward. And then, classify the data in according with ICD-10.Part Ⅱ:The self-design questionnaire was used to cross-sectional investigation of the hospitalized patients from the Kangjian community’ward (urban) and the industrial community’s ward (suburbs). The questionnaire includes general condition of patients, the disease, the economic situation, family situation, activities of daily living assessment and other. At last, double persons organized the data. Date from the survey was put into SPSS18.0data base.ResultsPart Ⅰ:(1) In Kangjian healthy communities, The ratio between over60years old and the number of the beds was1/130persons, and the occupancy rate was91.37%.(2) The average age was82.70±8.76years old, of which over60years old accounted for98.7%.(3)There was9system diseases. The ratio of the top three system diseases which were circulatory system, nervous system, tumors was85.2%. The single diseases of the top three was cerebral infarction, hypertension, coronary heart disease, the total ratio was70.16%.(5) Disease outcome with the "death" had a higher proportion of29.4%.(6) The average days in hospital was236.03, Within1year had accounted for74.8%. Part Ⅱ:(1) In the suburbs’healthy communities, The ratio between over60years old and the number of the beds is1/44persons, it was significantly higher than the city.(2)The spectrum of diseases is the common and chronic diseases.(3) the number of days of hospitalization, activities of daily living, on leave during hospitalization, independent housing, form of payment, monthly expenditure, hospital economic pressure to family, the number of family members’visitation, the purposes of inhospital, the degree of difficulty of admission and the chosen of the place after discharge of the two communities has the statistically significant.(4) logistic regression analysis shows that the influencing factors of long-term hospitalization has related to the purpose of hospitalization and the ADL’s core.ConclusionPart Ⅰ:(1) the healthy community wards is the station of imbalance between supply and demand. But the beds’supply only have satisfied25%of the required, especially the women’s beds.(2)The mainly object of service is the aged. Then the primary of the spectrum of disease are the common and chronic diseases.(3) Due to the increase of the elderly and the persons of hospice, the ratio of death is significantly higher than the national and Shanghai’s level.(4) The average days in hospital is very long.Part Ⅱ:(1)The mainly target of service is the aged. However, the number of beds is difficult to meet the actual needs, especially the city’s wards.(2) the primary of the spectrum of disease are the common and chronic diseases.(3)Through the economic analysis, we find the community wards have a high cost-effective.(4)Transportation developed has facilitated family visits.(5)The reason of patients don’t want to be discharged which contains the disease that impossible recovered, the family can not take care or no care of the patients and readmission difficult.(6)The average days in hospital is very long. The logistic regression analysis showed that there are two related causes. On the one hand, the hospital days to select nursing are higher than select medical patients in the question of hospital purposes. On the other hand, the ADL’s score is higher, the ratio of the length of hospital stay is lower. SuggestionPart Ⅰ:(1) Tertiary prevention.(2) To strengthen rehabilitation exercise, so as to return to the community.(3) Increase the hospice ward. Part Ⅱ:(1) Tertiary prevention, to reduce the need for hospitalization is the key.(2) Increase the number of beds at the community ward, especially the aged care beds. And to improve the effective utilization of beds.(3) Diversion to other agencies reduce the pressure of the community ward.(4) To strengthen rehabilitation exercise, so as to return to the community.(5)On the basis of the functional of the ward are separated into different wards.(6) Integrating resources and functional positioning for a variety of aged care resources.(7) To strengthen the support for vulnerable groups.