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目的:明确重庆市黔江区居民县域内再入院特别是跨级住院的水平、流向、费用及地域特征,为提升患者再入院服务质量及乡镇卫生院的吸引力提供依据。方法:选取重庆市黔江区2008—2013年的新型农村合作医疗住院数据运用Ex-cel 2010编程技术筛选得到14 395条再入院患者数据。用自体条件匹配技术比较患者跨级县级住院与相应的直接县级住院的费用水平。通过Arc GIS 10.0技术展示再入院患者的地区分布。结果:6年间黔江区再入院的比重基本保持在5%~6%,并逐年上升;再入院患者中县-县住院所占比重最大为40%左右,其次是乡-乡30%左右,乡-县17%左右;越是靠近省道国道的乡镇跨级比重越高,越是接近城区的乡镇县-县再入院路径比重越高,越是边缘的乡镇乡-乡再入院路径比重越高;虽然跨级住院的费用总是高于单次住院的费用水平,但其差异间无统计学意义。结论:患者再入院结构不合理,就医选择较为无序;空间可达性会影响患者再住院路径选择;县乡两级衔接不佳,跨级住院优越性没有得到体现。
Objective: To clarify the level, direction, cost and geographical characteristics of rehospitalization, especially cross-class inpatient residence in Qianjiang district of Chongqing, and provide the basis for improving the service quality of rehospitalization and the attractiveness of township hospitals. Methods: The new rural cooperative medical hospitalization data from 2008 to 2013 in Qianjiang district of Chongqing were selected to screen 14 395 hospital admission data using Ex-cel 2010 programming technology. Comparisons of patient-level and county-level hospitalization with the corresponding direct county-level hospitalization costs using self-matching techniques. Distribute regional distribution of patients on readmission with Arc GIS 10.0 technology. Results: In the six years, the proportion of rehospitalization in Qianjiang district remained at 5% -6% and increased year by year; the proportion of rehospitalized patients in county-county hospital was about 40%, followed by that of township-township about 30% - the county about 17%; the more close to the provincial highway cross the higher the proportion of townships, the closer the urban counties - the higher the proportion of county rehospital admission, the more marginal township - township rehospital admission the higher the proportion Although the cost of cross-class hospitalization was always higher than that of single hospitalization, the differences were not statistically significant. Conclusion: The structure of rehospitalization of patients is unreasonable, and the choice of medical treatment is disorderly. Spatial reachability affects the choice of pathways for rehospitalization. The connection between county and township is poor, and the superiority of trans-level hospitalization is not reflected.