基于十个单病种评价感控在国家三级公立医院绩效考核中的意义

Evaluation of significance of infection control in Performance Assessment of Tertiary Public Hospitals in China based on 10 types of single diseases

  • 摘要:
    目的 分析医院感染(HAI)对国家三级公立医院绩效考核(简称“国考”)中10个单病种患者住院天数和费用的影响,评价感控在“国考”中的意义。
    方法 选取2022年1-12月南京医科大学第一附属医院10个国考单病种患者资料,分析各单病种HAI发生率、HAI部位分布特点,并通过多因素分析评估HAI对住院天数和费用的影响。
    结果 各单病种HAI发生率中冠状动脉旁路移植术(CABG)最高(12.41%),其次为成人肺炎(4.70%)和心衰(2.25%)。不同单病种存在感染部位集中现象:CABG主要为下呼吸道感染,髋关节置换以泌尿道感染为主。多因素分析结果显示,除慢性阻塞性肺病(COPD)和成人肺炎外,HAI延长其他单病种住院天数(P<0.05),其中髋关节置换(增加22.05 d)、心衰(增加18.39 d)和心梗(增加17.15 d)最为显著;CABG、COPD、髋关节置换、脑梗、心梗和心衰患者因HAI导致的医疗费用增加(P<0.05),其中心衰组增幅最大(增加251 662.92元)。
    结论 HAI对大多数单病种患者的住院天数和医疗费用均产生显著负面影响,加强HAI防控工作不仅能提高医疗质量和患者安全,还能有效改善三级公立医院绩效考核指标,促进医疗机构高质量发展。

     

    Abstract:
    OBJECTIVE To observe the impact of hospital-associated infections (HAIs) on length of hospital stay and medical costs of the patients with 10 single diseases included in the Performance Assessment of Tertiary Public Hospitals in China (referred to as the National Assessment) and evaluate the significance of infection control in the 'National Assessment'.
    METHODS The data were collected from the patients with 10 single diseases covered by the National Assessment who were treated in The First Affiliated Hospital of Nanjing Medical University from Jan. 2022 to Dec. 2022. The incidence of HAIs and the infection sites of the patients with the single diseases were analyzed. Multivariate analysis was performed for the assessment of impact of the HAIs on the length of hospital stay and medical costs.
    RESULTS Among the patients with the single diseases, the incidence of HAIs was the highest (12.41%) in the patients undergoing coronary artery bypass grafting (CABG), followed by adult pneumonia (4.70%) and heart failure (2.25%). There was gathering of infection sites among the patients with the different single diseases: lower respiratory tract was the major infection site among the patients undergoing CABG, and the urinary tract was the major infection site among the patients undergoing hip replacement. Ther result of multivariate analysis showed that the HAIs could extend the length of hospital stay of the patients with all the single diseases except for chronic obstructive pulmonary disease (COPD) and adult pneumonia (P < 0.05); the lengths of hospital stay of the patients undergoing hip replacement (with the increase of 22.05 days), the patients with heart failure (with the increase of 18.39 days) and those with myocardial infarction (with the increase of 17.15 days) increased most remarkably. The medical costs of the patients with CABG, COPD, hip replacement, cerebral infarction, myocardial infarction and heart failure were increased due to the HAIs (P < 0.05), and the medical costs of the patients with heart failure increased most remarkably (with the increase of 251, 662.92 yuan).
    CONCLUSIONS The HAIs have remarkable negative effects on the length of hospital stay and medical costs of most of the patients with single diseases. It is necessary to strengthen the prevention and control of HAIs so as to improve the medical quality, guarantee the safety of patients, effectively improve the performance assessment indexes for tertiary public hospitals and facilitate the high-quality development of medical institutions.

     

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