| BACKGROUND: In recent years,with the development of social,urbanization and aging has become more and more serious,facing the increasingly complex health problems,chronic non communicable diseases have become the main disease burden,sub-health population are expanding.The layout of health resources and health service mode are facing new challenges.The overall reform tasks are clearly proposed to build a complete system,a clear division of labor,complementary functions,in close collaboration with the integrated health service system,the establishment of clinics grading system,promote the equalization of basic medical and health care,to alleviate the difficult and expensive problem.Although the discharge can not directly reflect the prevalence level of population and the level of death spectrum of patients with diseases,but the statistical object is the prevalence of the illness is serious,requiring hospitalization,the diagnostic information comes from a reliable source encoding relatively accurate classification of diseases.Therefore,the researchof disease spectrum of patients discharged one can understand the population burden of disease and health service demand,provide a reference for determining the key for disease prevention and control as well as the prevalence of hospitalization demand.On the other hand,the composition of the discharge spectrum of different hospitals also reflects the flow of medical treatment and the service ability of different hospitals.The domestic use of hospital admission or disease constitutes many changes of disease spectrum classification,but mostly confined to a hospital or a few hospitals of all hospital records analysis has not been reported;and the use of hospital records of grading treatment study are rare.On the basis of the domestic and foreign research methods of Chongqing city in 2016 all hospital patients discharged diseases investigation and comprehensive analysis,to determine the Chongqing patients discharged from the disease constitution and characteristics,and makes a comparative analysis of different regions and different grades,different hospital diseases,in order to provide reference basis for establishing Chongqing classification diagnosis and treatment system.OBJECTIVE: ·To find out the current burden of disease in different regions,different time periods,different gender and age groups in Chongqing.Provide reference for medical and health resources distribution.·To analyze the difference between discharged patients in different levels of hospitals and different administrative levels of the Grade-Three Hospitals,to provide a reference for the next step to develop a scientific grading system.·Analysis of the differences between public hospitals and private hospitals to provide reference for the development of private hospitals.METHODS : With the analysis of the disease spectrum in 699 hospitals of Chongqing,according to the International Classification of Diseases,ICD-10,classification and statistical encoding,with the first diagnosis of discharged patients as the criterion.Statistical analysis of the composition and ratio of various diseases in 699 hospitals,and the quarterly,age and gender of the disease constitution of discharged patients.Based on the data obtained,the author makes a comparative analysis of different grades,different regions and different hospitals.Chi square test was used to compare the disease constitution.RESULTS: In 2016,there are totally 3183727 discharged patients in the 699 hospitals,in which the female is higher than male patients(47.04% male,52.25% female).People over the age of 60 accounted for the highest,reaching 41.22%,5-14 years old young people accounted for only 3.37% of the minimum.From the regional distribution of hospital patients,the proportion of new urbandevelopment accounted for 30.26%,the lowest ecological protection development area in Southeast Chongqing,accounting for 8.05%.(we can discuss the relationship between the bed and the patient).From the patients' s sources,outside Chongqing accounted for 4.22%,of which the highest proportion is the southeast of Chongqing(4.southeast Ecological Protection Development Zone,accounting for up to 9.7%,the lowest is the Northeast Ecological Conservation Development Zone,only 0.09%.In 2016,the top 10 diseases of discharged patient were: other chronic obstructive pulmonary disease,Chronic ischemic heart disease,pneumonia,chemotherapy,Brain infarction,Head Eutocia,acute bronchitis,idiopathic(primary)hypertension,gastritis and duodenal inflammation and other diseases of intervertebral discs.Disease distribution is different in different areas(X 2=41.66,P < 0.001),chemotherapy ranked first at metropolitan area,and other chronic obstructive pulmonary disease are in the first row at the city development area and northeast of Chongqing,pneumonia is in the first row at Southeast Chongqing.Birth is ranked in the top 5 at the city development area,northeast and southeast of Chongqing,ranked twelfth in the metropolitan area;in addition to southeast of Chongqing,chemotherapy did not enter the top 20,other areas are in the top 20,ranked seventh at the northeast of Chongqing;At southeast Chongqing,hemorrhoids enters the top 20,but in the other three areas,it are not in the top 20,intracranial injury is into the top 20 at thenortheast and southeast,but at the urban area and the city development area,it did not enter;other cerebrovascular disease in urban areas and the city development area were in the top 20,but did not enter top 20 at the northeast and southeast of Chongqing.Different gender patients have different spectrum of disease,other chronic obstructive pulmonary disease is in the first row in male patients.with the head of a female birth is ranked first in female,but In addition to gender related diseases,disease constitutes of different gender patients is no significant difference(X 2=0.495,P>0.05).The constitutions of the top 20 diseases in different age discharged patients are no the same.Under the age of 5,the number of the first 20 diseases were about 74.94% of the total number of discharged patients,the top 3 were: pneumonia(20.66%),bronchitis(7.76%),neonatal jaundice(6.73%).Between the age 5~14,the number of the first 20 diseases were about 55.42% of the total number of discharged patients,the top 3 were: acute tonsillitis(9.77%),acute bronchitis(7.69%),pneumonia(7.36%).In the 15~44 group,the number of the first 20 diseases were about 37.95% of the total number of discharged patients,and the top 3 were :head eutocia(7.92%),selective cesarean delivery(4.68%),and pregnancy premature rupture of mem-branes(2.47%).In the 45~59 group,the number of the first 20 diseases were about 36.10% of the total number of discharged patients,the top 3 were:chemotherapy(4.38%),other disc diseases(2.97%),gastritis and duodenal inflammation(2.33%).In the 60~ age group,the top 20 diseases accounted for the total number of hospital discharge 52.43% of the total number of discharged patients,the top 3 were: other chronic obstructive pulmonary disease(8.48%),chronic ischemic heart disease(7.41),cerebral infarction(4.87%).From the first quarter to the fourth quarter,the number of discharged patients gradually increased slowly,basically stable.The top 20 diseases are basically the same in each quarter;The proportion of the top 20 diseases in the four quarters is also relatively similar,are between 34%-39%.The constitution of diseases is different in different levels of hospital(X 2=19.25,P < 0.001).Chemotherapy is the top 1 disease in the tertiary hospitals,but did not enter the top 20 in the second-class and below hospitals;Other chronic obstructive pulmonary disease is the top 1 disease in the second-class and below hospitals.In the top 20 diseases of the three classes hospitals there are 13 same kinds of diseases.In 2016,there were 762814 discharged patients in private hospitals,accounting for about 20% of the total number of discharged patients.The number of discharged patients in public hospitals is accounting for about 80%.The consist of diseases in Public hospital and private hospital is not the same(X 2=21.647,P<0.001).CONCLUSIONS: ·From the analysis of discharged patients,currently the mainly disease in Chongqing is respiratory system,cardiovascular system,tumor,gastroenteritis,intervertebral disc,diabetes,gallstones or kidney stones,senile cataract,chronic non communicable diseases,these have become major disease burden.With the Two-child policy,women's reproduction and related hospital services has become one of the main diseases,the head eutocia is the main mode of production,much higher than caesarean section.There was no difference between male and female except for special diseases related to sex.·Analyzing the provide services of different areas,southeast of Chongqing is relatively weak,the ability to provide high-end services such as chemotherapy was significantly lower than other areas,due to municipal hospital aggregation,urban areas service ability is the strongest,chemotherapy is the first in their disease constitutes.·Under the age of 15,the main diseases is respiratory tract infection.Between the age of 15~44,the mainly diseases are the gynecology and Obstetrics Diseases(accounted for 5).Middle-aged 45~59 is susceptible to tumor threat.Over the age of 60 diseases,cardiovascular and respiratory system disease are the mainly.So,we should strengthen maternal and child health,strengthen the screening of middle-aged to promote the comprehensive prevention and control of chronic diseases.·Base on the inpatient service,grading treatment system was basically established.The constitute of discharged patients diseases in tertiary hospitals and second-class hospitals are not the same,but there are still many simple In-hospital Service in tertiary hospitals.There are no different in constitute of discharged patients diseases between municipal tertiary hospitals and district tertiary hospitals. |
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