OBJECTIVE  To analyze the changes in the disease spectrum of patients from the respiratory medicine outpatient department of a three-A hospital in Zhengzhou City with analytical tools such as Pareto diagrams and rank-sum ratios (RSR), and to provide a reference for adjusting outpatient diagnosis and treatment strategies for respiratory diseases and flexibly allocating outpatient medical resources.

METHODS  A retrospective analysis was conducted on the clinical data of patients who visited the Respiratory Medicine Outpatient Department of Zhengzhou Central Hospital Affiliated to Zhengzhou University from Jan. 1, 2018, to Dec. 31, 2024. The data were divided into three stages based on time nodes: Stage 1 (Jan. 1, 2018, to Dec. 31, 2019), Stage 2 (Jan. 1, 2020, to Dec. 31, 2022) and Stage 3 (Jan. 1, 2023, to Dec. 31, 2024). For each stage, 10% of the outpatient patients were selected as a sampling sample. A Pareto diagram curve was constructed based on the diagnosis classification of respiratory diseases, and RSR-related parameters for each diagnosis classification were calculated. The changes in the disease spectrum of the Respiratory Medicine Outpatient Department across the three stages were analyzed based on the above curve and parameters.

RESULTS  The main diagnostic differences among the three stages of respiratory medicine outpatient department were statistically significant, with no consistency in the disease spectrum (H=258.496, P＜0.001), tracheobronchial lesions and acute upper respiratory tract infections were the main diagnoses, with cumulative proportions of 48.54%, 42.60% and 37.72%, respectively, in the three stages. Their RSR fitting values were 1.000 and 0.957, respectively. In the second stage, the proportion of viral respiratory system infections increased by 8.63%, and the proportion of allergic diseases increased by 1.75%. Their RSR fitting values were 0.720 and 0.641, respectively. In the third stage, pulmonary imaging abnormalities and non-viral pneumonia entered the main diagnostic sequence, ranking third and fourth, with proportions of 12.80% and 10.14%, respectively. Their RSR fitting values were 0.888 and 0.819, respectively.

CONCLUSIONS  There are significant changes in the disease spectrum of respiratory medicine outpatient department from 2018 to 2024, presenting a three-tier structure of "core diseases such as tracheobronchitis or other tracheobronchial lesions, acute upper respiratory tract infections dominating throughout the entire process, and mid-stage viral infections driving the transformation towards differentiated management of chronic respiratory diseases in the later stage". Doctors are reminded to avoid overdiagnosis of respiratory infectious diseases and focus on standardized diagnosis and treatment of chronic respiratory diseases such as chronic airway diseases and early lung neoplastic diseases. Analysis of changes in the disease spectrum of respiratory medicine outpatient department based on Pareto diagram and RSR values is helpful for achieving precise management of the respiratory medicine outpatient diagnosis and treatment system.