Status Quo In Distribution,hierarchical Diagnosis And Treatment Of Multicentral Inpatient With Chronic Obstructive Pulmonary Disease In Xiangtan

Objective:To investigate the current situation of distribution and hierarchical diagnosis and treatment of multicentral inpatients with chronic obstructive pulmonary disease?COPD?in Xiangtan,further promote the hierarchical diagnosis and treatment of chronic obstructive pulmonary disease by understanding the current status of grassroots chronic disease management of chronic obstructive pulmonary disease in Xiangtan.Methods:Patients with the first diagnosis of acute exacerbation of chronic obstructive pneumonia who were discharged between January 1,2018and December 31,2018 from five hospitals of which were two tertiary hospitals?The First People's Hospital of Xiangtan and Xiangtan Central Hospital?and three secondary hospitals?Xiangxiang People's Hospital,Xiangtan County People's Hospital,and Shaoshan People's Hospital?were included in this survey.The patient's blood gas analysis report and pulmonary function report during hospitalization were investigated based on the patient's name and hospitalization number.Patients were divided into subgroups according to their blood gas analysis:completed examination of blood gas analysis group?Group A?and uncompleted examination of blood gas analysis group?Group B?;Patients in group B were further divided according to the result of blood gas analysis:PaO₂<60 mm Hg with or without PaCO₂>50 mm Hg was placed to respiratory failure group;PaO₂?60 mm Hg with PaCO₂?50 mm Hg was classified as non-respiratory failure group.They were grouped according to lung function examination refinement:uncompleted examination on pulmonary function?Group C?and completed examination on pulmonary function?Group D?.Patients of group D were sub-grouped additionally according to pulmonary function:Mild obstructive ventilation dysfunction?mild group?,Moderate obstructive ventilation dysfunction?moderate group?,Severe obstructive ventilation dysfunction?severe group?,Very severe obstructive ventilation dysfunction?very severe group?.By statistical analyzing the number of patients in the respiratory failure group,non-respiratory failure group,mild group,moderate group,severe group and very severe group in the secondary and tertiary hospitals,the distribution of patients with different levels of chronic obstructive pulmonary disease in the secondary and tertiary hospitals was assessed,subsequently analyze any statistical differences,the current status of hierarchical diagnosis and treatment of the patients with chronic obstructive pulmonary disease in the secondary and tertiary hospitals in Xiangtan area.The number of bidirectional referrals of inpatients with slow obstructive pulmonary disease in five hospitals in 2018 has been investigated to analyze the status of the hierarchical diagnosis and treatment of chronic obstructive pulmonary disease in the Xiangtan area.The number of patients with chronic obstructive pulmonary disease in the Xiangtan area who were included in the grassroots chronic disease management as of December 31,2018 was investigated through the National Basic Public Health Services Project Management Information System.A comparison of all inpatients with COPD in five hospitals in 2018 was conducted to understand the current status of grassroots chronic disease management of CDPD in Xiangtan area.The collected data were statistically processed using SPSS 26 statistical software.Results:1.The differences in age,sex,occupation,and nutritional status of the patients enrolled in the secondary and tertiary level hospitals in Xiangtan were not statistically significant.2.The distribution of patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure in Xiangtan area between secondary and tertiary hospitals was not statistically significant.3.Differences in the distribution of patients with different degrees of hypercarbonemia in secondary and tertiary hospitals in Xiangtan were statistically significant.4.The difference in the PaCO₂ indicator between patients with acute exacerbation of chronic obstructive pulmonary disease and severe hypercarbonemia secondary and tertiary hospitals in Xiangtan was not statistically significant.5.There was a statistically significant difference between secondary and tertiary hospitals in Xiangtan area in the completeness of blood gas analysis examination of patients with COPD.6.No statistically significant difference in the distribution of COPD patients with different degrees of lung function among the secondary and tertiary hospitals in Xiangtan.7.The difference in the completeness of pulmonary function assessment of patients with COPD in 2018 was statistically significant among the second and third-tier hospitals in the Xiangtan area.8.In 2018,Xiangtan Central Hospital received a total of 37 people transferred from the grassroots health service center,0 people transferred to the grassroots health service center;in the same year,the First People's Hospital of Xiangtan received 76 people transferred from the grassroots health service center and no one downward transferred to the grassroots health service center.The numbers of transferred patients were not available for the remaining three hospitals?there were no appropriate departments or systems in place for hierarchical referrals?.The number of upward referrals to five hospitals in 2018 was only 1.11%of the total number of patients admitted with COPD,and downward referrals were 0%of the total number of referrals.9.As of December 31,2018,the number of patients with COPD in the Xiangtan area included in the grassroots chronic disease management system in total was 480 cases.Only 89 inpatients with COPD of the five hospitals were included in the grassroots chronic disease management system.The number of COPD patients included in the grassroots chronic disease management system represented 0.99%of total COPD admissions in the five hospitals in 2018.Conclusion:The grading diagnosis and treatment system of copd in xiangtan area needs to be further improved;The implementation of bidirectional referral of COPD patients in Xiangtan still needs to be improved;the management of COPD patients in grassroots chronic disease management in Xiangtan still has a long way to go.