2024年南宁市三所妇幼保健院非医嘱离院特征及因素分析OA
Analysis of the characteristics and factors of discharge against medical advice from three maternal and child health care hospitals in Nanning City in 2024
目的 分析2024年南宁市三所妇幼保健院住院患者非医嘱离院的分布特征,探讨心理社会因素对非医嘱离院的影响,为制定干预策略提供依据.方法 采用前瞻性研究设计,纳入2024年1-12月南宁市妇幼保健院、南宁市第二妇幼保健院、马山县妇幼保健院10 039例出院患者的病案资料,统计非医嘱离院的发生率与科室、疾病分布特征;采用多因素logistic回归模型分析非医嘱离院的影响因素.结果 10 039例出院患者中非医嘱离院共368例,发生率为3.67％;非医嘱离院患者主要集中在儿科(264例,71.74％)、新生儿科(41例,11.14％)、产科(33例,8.97％),疾病类型以呼吸系统疾病(258例,70.11％)、消化系统疾病(46例,12.50％)、妊娠相关疾病(38例,10.33％)为主.多因素logistic回归分析显示:病情重(OR=3.083)、治疗费用≥ 10 000元(OR=3.397)是非医嘱离院的独立危险因素(P均＜0.01);住院天数＜7 d(OR=0.510)、门诊/其他途径入院(OR=0.520)、一般自我效能感量表(GSES)高评分(OR=0.471)、领悟社会支持量表(PSSS)高评分(OR=0.440)是其保护因素(P均＜0.01).结论 南宁市三所妇幼保健院非医嘱离院的发生与住院天数、入院途径、病情严重程度、治疗费用及患者自我效能、社会支持水平密切相关,医院可针对上述特征与影响因素制定分级干预策略,降低非医嘱离院发生率.
Objective To analyze the distribution characteristics of discharge against medical advice(DAM A)among inpatients in three maternal and child health hospitals in Nanning City in 2024,and explore the impact of psychosocial factors on DAM A,so as to provide evidence for formulating intervention strategies.Methods A prospective study design was adopted,and the medical record data of 10 039 discharged patients from Nanning Maternal and Child Health Hospital,the Reproductive Hospital of Guangxi Zhuang Autonomous Region,and Mashan Maternal and Child Health Hospital from January to December 2024 were collected.The incidence of DAMA and its distribution characteristics by department and disease type were calculated.In addition,multivariate logistic regression model was used to analyze the influencing factors of DAMA.Results Among the 10 039 discharged patients,368 cases were DAM A,with an incidence rate of 3.67％.The DAMA patients were mainly concentrated in pediatrics(264 cases,71.74％),neonatology(41 cases,11.14％),and obstetrics(33 cases,8.97％).The main disease types were respiratory system diseases(258 cases,70.11％),digestive system dis-eases(46 cases,12.50％),and pregnancy-related diseases(38 cases,10.33％).Multivariate logistic regression analysis showed that severe condition(OR=3.083)and treatment cost≥10 000 yuan(OR=3.397)were identified as independent risk factors for DAMA(all P＜0.01);length of stay＜7 days(OR=0.510),admission through outpatient/other channels(OR=0.520),high score on the general self-efficacy scale(GSES)(OR=0.471),and high score on the perceived social support scale(PSSS)(OR=0.440)were protective factors(all P＜0.01).Conclusion The occurrence of DAMA in the three maternal and child health hospitals in Nanning City is closely related to length of hospital stay,admission route,severi-ty of condition,treatment cost,patients' self-efficacy and social support level.Hospitals can develop hierarchical intervention strategies based on the above-mentioned characteristics and influencing factors to reduce the incidence of DAMA.
卢芳玲;韦慧;李楠;黄玲;罗金云
广西南宁市第二妇幼保健院病案室,广西南宁 530299广西壮族自治区生殖医院广西人类辅助生殖技术管理中心办公室,广西南宁 530218广西壮族自治区生殖医院胚胎实验室,广西南宁 530218广西南宁市妇幼保健院病案科,广西南宁 530011广西南宁市马山县妇幼保健院病案科,广西马山 530699
医药卫生
非医嘱离院分布特征心理社会因素自我效能
discharge against medical advice(DAMA)distribution characteristicpsychosocial factorself-efficacy
《右江医学》 2026 (5)
476-482,7
广西医疗卫生适宜技术开发与推广应用项目(S2024127)
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