Analysis Of Inpatients Readmission Of Five County Medical Hospitals In Liaoning Province In A Year

The implementation of the Hierarchical Diagnosis system helps to standardize medical process,is conducive to the rational use of medical resources and helps to solve the difficulty of expensive medical treatment problem.Fully implementing grading diagnosis and treatment,the first option at the grass-roots level,strengthen the construction of grassroots medical institutions and the cooperation medical treatment between different medical institutions,is an important task of national much starker choices-and graver consequences-in.It is an important content of reform that public hospitals participate in hierarchical diagnosis and treatment,receive hard-treat and emergency cases,and let the frequently-occurring disease/stabilization and recovery in patients turn down.Two-way referrals are an important way to grade diagnosis and treatment,to improve the rural medical and health services,strengthen the construction of public hospitals at the county level and improve urban and rural counterpart support policies,and promot the implementation of bi-directional referral system,is the next step of the reform of public hospitals.County hospital is an important link of rural health service system,and service 80% of the rural areas;the connection of tertiary general and townships hospitals and the bibcock of three-level health service network,and plays an essential role in the implementation of two-way referral.Since 2011,the "return classes" is widely used in tertiary general hospital medical quality management work as an important evaluation index of medical quality management.In recent years,the repeat phenomenon in county hospital is rising.County hospital should bear acute phase and transfer to a rehabilitation hospital or in towns and townships of chronic disease on the non-acute stage as well as comprehensive hospitals.public hospitals at the county level should establish cooperation mechanism with townships hospitals,rehabilitation institutions and other kinds of medical institutions,letting patients' sick can cure.But patients still choose to stay in the general hospital.This will lead to a large part of high quality medical resources can not be used reasonably and rising medical costs.Objective: Through analyzing basic conduction and the reasons of patients that not transfer to townships hospital and other specialized subject hospital of the five county medical hospitals in Liaoning province,to provide the basis for the implementation of the grading system.Public county hospitals are in very important position in the countryside.In the case of medical resources nervous,the medical resources of county and township medical institutions can be reasonable used or not,and how to reduce the unreasonable repeat the number of readmission patients,and change the patient's medical treatment behavior,is worthy of attention and research.Methods: 1.Literature research;2.Theoretical analysis: Using the theory of health service demand,health service supplying behavior theory and related theories in new institutional economics to analysis the main behaviors of hospitalized patients;3.Quantitative research: Using statistical methods to analysis basic conductions and the distribution of disease hospitalized readmission patients;4.Qualitative interviews: Looking for repeat subjective and objective reasons of hospitalization of patients through interviews.Results: There are two third class and second level and three second class and first level hospitals;There are repeated phenomenon in five county medical institutions,the number of B hospital's hospitalized patients up to 573;There is 42052 trips of five hospitals in total,and 4545 trips and 1587 persons of hospitalized patients above of 18 years(including 18),accounting for about 10.81%;The repeated hospitalization rate of Yingkou hospitalization is the highest(23.77%),and D hospital is the lowest(1.18%);The number of women is larger than men;In the majority with elderly patients over 40 age;Hospitalized patients with repeated twice in the majority,A hospital inpatients hospitalized repeated times are 2 times;The average medical expense of patients hospitalized for the first time is higher than readmission;The average hospitalization days of patients hospitalized for the first time is more than readmission;From the distribution of diseases,chronic diseases such as cancer,cardiovascular disease is major diseases.From Interview results,besides patients own disease factors,hospitals' development to expanse of beds,the reimbursement policy,the department of revenue,doctors benefit are also the reasons of acute recurrent hospitalization.Moreover,patients' mistrust of the townships technology,institutes of technology level is low,or lack of equipment and drugs,institutes of health,the lack of maintenance courtyard surrounding the county hospital,and the imbalance of the medical resource allocation,also lead patients unwilling to turn down townships and stay in the county hospital.Conclusion: Coronary heart disease,malignant tumor,cancerl infarction,cerebral infarction,viral hepatitis,kidney disease,diabetes,chronic obstructive pulmonary disease,high blood pressure,and aplastic anemia are the main diseases of the repeated hospitalization.The age of hospitalized patients are focused on the elderly patients over the age of 40.Main reasons:(1)Lack of care in hospital(or maintenance yards)diseases such as chronic medical support institutions;(2)Basic health service ability is insufficient or equipment drugs is not complete,cannot undertake the slow disease such as cancer,cardiovascular disease management services;(3)The patient or family mistrust of grass-roots service ability;(4)Unreasonable medical behaviors that because of the little Government financial aid.