| [Purpose]The coexistence of the shortage and waste of China's medical resources was revealed by insufficient high-quality medical resources,excessive use of in-hospital services,as well as the growth of medical insurance fund spending beyond the speed of financing,which indicates the risk of unsustainable operation of medical insurance fund has soared.How to evaluate the rational use of hospital medical resources has become an urgent problem to be solved.This study aims to draw lessons from domestic and foreign assessment methods and experiences of suitability hospitalization days,combined with the actual medical and health work in China to develop identification standards and models of ineffective hospitalization days,identifying unreasonable hospitalization time of surgical patientscovering all the hospital medical procedures whose medical costs are relatively high in order to analyze the status of ineffective hospitalization in the three-level general hospital,and to analyze the factors that affect the ineffective hospitalization day from the aspects of suppliers and demanders of medical services,society and so on;based on Lean Management and Bayesian game theory further,we are to establish a concept model of management strategy of ineffective hospitalization time,and then to provide targeted tacticsrespectively,which provide theoretical and empirical basis to help hospitals strengthen internal management,and to help health administrative departments to optimize the allocation of medical resources and health insurance departments to strengthen the rational use of funds,etc.[Methods](1)Literature research:To access to domestic and foreign literature on the evaluation of hospital suitability,China's hospital management on the relevant laws and policy documents,and to provide the proof for the construction of ineffective hospitalization date identification criteria and evaluation model,and the establishment of index system of ineffective hospitalization day influence factors.(2)Expert consultation:On the basis of literature research,we selected 25 experts with clinical and mangement experiences from tertiary hospitals for consultation twice,establishing identification standards and index systems of influencing factors of ineffective hospitalization days by using Delphi method and focal group interview comprehensively.(3)Questionnaire:Based on The Index System of Influencing Factors of Ineffective Hospitalization in Tertiary General Hospitals,the questionnaires were prepared according to Likert 5 scale method,aiming to know the attitude of clinical practitioners,nurses and monitors of hospitals to above influencing factors' effect.In order to ensure the homogeneity of the sample hospitals and the scientificity of the sampling,we have taken full account of the distribution of medical and health resources in various regions of China,according to the total number of discharged patients of tertiary hospitals in the eastern,central and western regions in 2014(East:Central:West=1.5:1.25:1),we used stratified random sampling method to select five tertiary general hospitals from each region,and from each hospital we randomly selected surgical department clinicians,nurses and hospital medical Management of the 60 people,50 people,40 people,a total of 750 people involved in the survey.(4)Factor analysis:The principal component analysis was used to analyze the result of questionnaire survey on influencing factors,and then we reclassified those influencing factors,and further explore the internal structure of the evaluation index of ineffective hospitalization factors,and formulated the table of causes of ineffective hospital days based on the foregoing result.(5)Case retrospective analysis:Three kinds of cases of operation records were taken from the sample hospital by carrying on typical sampling and isometric sampling together,a total of 408 cases were used as samples,which adds up to 4986 days in all.We conducted relevant clinical and nursing experts to use the identification index of ineffective hospitalization date and the cause analysis table to evaluate each hospital day and analyze the status of hospitalization of the three-level general hospital.In the case of the analysis of the information and cause of the patient's medical record,we ran quantitative analysis of influencing factors of invalid hospitalization day by mathematical statistics method.[Results](1)The identification index system and evaluation model of the inpatient days of the three-level general hospital patients with Chinese characteristics were established?There were 19 criteria for the identification of the index system including three major aspect-medical service,nursing/life support service and patient status.(2)The influencing factors set of ineffective hospitalization days of three-level general hospital patients were established,and the influencing factors were divided into three aspects:medical factors,factors of patient and social factors,a total of 21 factors;we developed The Questionnaire about The Influencing Factors of Ineffective Hospitalization Days of Three-level General Hospital Patients and The Table of Causes of Ineffective Hospital Days.(3)Study on cases showed that there are 78.43%of surgicalpatients in tertiary general hospitals with ineffective hospitalization in China,ineffective hospitalization time accounts for 21.13%of total length of stay.The average length of stay was 3.58 days,of which the average preoperative hospital stay was 1.19 days,the average postoperative hospital stay was 1.39 days.(4)The results of qualitative analysis of influencing factors of ineffective hospitalization days of surgical patients in three-level general hospitals showed that medical factors,factors of patient and social factors were extracted from factor analysis in which medical factors' contribution rate were 46.27%,contribution rate of factors of patients accounted for 8.86%,and contribution rate of social factors were 5.33%,the cumulative contribution rates were up to 60.56%.(5)The results of quantitative analysis of influencing factors of ineffective hospitalization days of surgical patients in three-level general hospitals showed that medical factors and patient factors are the mainly factors,not including social factors Conservative management concept of doctors,booking or reporting delays,surgical or operational delays,ineffective hospitalization led by patients or their families requiring to extend the hospitalization time,these top five factors accounted for more than 90%cumulatively.(6)The age of the patient,the route of admission,or the presence of multiple diseases,the level of surgical incision,whether or not the use of ventilator after surgery were significantly associated with the ineffective hospitalization of the three-stage general hospital.[Conclusions](1)China has not yet established the hospitalization suitability evaluation index.In this study,we used the literature analysis and expert consultation to establish a invalid hospitalization identification index system and a evaluation model for three-level general hospital surgery patients,which are widely applicable to all surgical departments,and easy to operate.Ineffective date of hospital can be identified,and its causes can be analyzed effectively.(2)The whole situation of ineffective hospitalization of surgical patients in three-level general hospital is not optimistic.The proportion of patients with ineffective hospitalization is high,and the proportion of ineffective hospitalization days is high,too.To some extent,this increases the burden of patients to a certain extent,increasing the medical security risk of cross-infection in hospital,and resulting to severe waste of medical resources.(3)The factors affecting the ineffective hospitalization of the three-level general hospital mainly include the medical,the patient and the social factors,among which the most influential factors are the medical factors,followed by the factors of the patients,and the social factors.Medical factors cover the poor medical procedures,lack of resources,doctors conservative patient management philosophy and so on.Patient factors are that patients requiring extended hospital stay,refusing to go home or to discharge.Social factors are mainly economic factors,including differences in medical insurance claims policy.(4)Aiming at the influencing factors of ineffective hospitalization days,the conceptual model of invalid hospitalization management was constructed based on the related thoughts of lean management and game decision-making.Taking management measures to the doctors,patients and social initiatives to different,can effectively reduce the ineffective hospitalization days,which has important significance for promoting the effective use of medical resources and safeguarding the operation of health insurance fund.(5)From the aspect of hospital,management strategies to reduce the ineffective hospitalization in the three general hospitals are the introduction of clinical path management thinking,standardizing the diagnosis and treatment process;rational allocation and use of medical resources;reorganization of medical service processes concentrated on patients.(6)From the aspect of patient,management strategies to reduce the ineffective hospitalization in the three general hospitals are paying attention to patient education,and strengthening communication between doctors and patients;identification of special status patients to take measures timely.(7)From the aspect of society,management strategies to reduce the ineffective hospitalization in the three general hospitals are medical insurance payment system reform;improving the hierarchical treatment system construction.[Innovations and deficiencies](1)InnovationsIn theory,by using the international evaluation tools such asUR and AEP,combined with the actual domestic medical work,this paper constructs an evaluation standard and model of inpatient suitability suitable for Chinese condition,and establishes a set of ineffective hospitalization evaluation tools suitable for China,which enrich the application of induced demand theory in evaluating the rational utilization of medical resources.Meanwhile,the qualitative research and quantitative research methods were used to analyze the influencing factors of invalid hospitalization days.In perspective,based on the appropriate evaluation of hospitalization services,this project explored the factors influencing the suitability of health services for hospitalization from the perspective of suppliers and demanders of medical services,and hospital managers.The research perspective is novel and realistic,and the research results will provide references for the enrichment of the theory of induced demand,and the improvement of the hospital service quality management and the security payment of medical insurance fund.(2)DeficienciesSubject to the limitations of the objective conditions,the research failed to implement the experimental intervention of ineffective hospitalization days.In addition,because the research object is limited to Hubei Province,the national extension of its conclusions needs to be further verified. |
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