• 王洪涛,李晨阳,王伟平*,范丽达,杨晓宇,王 欢.肿瘤专科医院非医嘱离院现况分析△[J].江苏卫生事业管理,2024,35(4):517-520.
  • 肿瘤专科医院非医嘱离院现况分析△
  • Analysis on the Current Situation of Patients Who Discharged from the Tumor Hospital without Advice of Doctor△
  • 王洪涛  李晨阳  王伟平*  范丽达  杨晓宇  王 欢
    天津医科大学肿瘤医院医务处,病案室,国家恶性肿瘤临床医学研究中心、天津市恶性肿瘤临床医学研究中心、天津市肿瘤防治重点实验室;天津医科大学肿瘤医院医务处,国家恶性肿瘤临床医学研究中心、天津市恶性肿瘤临床医学研究中心、天津市肿瘤防治重点实验室
  •   
  • DOI:
  • 中文关键词:

    肿瘤专科医院  非医嘱离院  现况分析

  • 英文关键词:

    Tumor Hospital  Against Medical Advice Discharge  The CurrentSituation

  • 基金项目:

    天津医科大学医院管理创新研究项目(2023YG08);国家卫健委医院管理研究所医疗质量循证管理持续改进研究项目(YLZLXZ22G048);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)

  • 摘要点击次数: 257    全文下载次数: 251
  • 中文摘要:

    目的:了解肿瘤患者非医嘱离院的临床分布特征与原因,提出相应对策,以降低非医嘱离院发生率。方法:回顾性收集2020年1月1日-2023年9月30日某肿瘤专科医院中非医嘱离院的肿瘤患者共431例,采集临床信息进一步分析。结果:非医嘱离院发生率为0.2%,非医嘱离院患者平均年龄为58.62岁;其中男性占比(59.9%)略多于女性(40.1%);平均住院天数为8.01天;首次住院患者265例(61.5%);恶性肿瘤患者379例(87.9%),其中发生转移的有187例(49.3%);肿瘤内科非医嘱离院行为多发(242例,56.1%)。恶性肿瘤非医嘱离院患者中占比排名前三的病种分别是肝胆恶性肿瘤(38.8%)、支气管和肺恶性肿瘤(14.8%)、胰腺恶性肿瘤(7.9%)。手术、抗肿瘤药物治疗和放疗的诊疗计划执行率分别是59.6%、76.4%和84.6%。非医嘱离院排名前四的原因分别是个人主观原因拒绝下一步治疗(占36.4%)、病情危重,家属放弃(占12.5%)、拒绝放化疗等内科治疗(占12.1%)和因风险放弃手术及有创操作(占11.6%)。结论:非医嘱离院行为多发于肿瘤内科和首次就诊患者,以预后差的恶性肿瘤为主,治疗策略的依从性低,是患者、疾病、医院等多种因素综合作用的结果。本研究可为制定相关干预措施提供参考,以优化恶性肿瘤医疗质量。

  • 英文摘要:

    Background:It is of great significance to understand the clinical distribution characteristics and direct causes of patients leaving the hospital without adviceof doctors,and propose corresponding measures to reduce the rate of against medical advice discharge. Methods:431 cancer patients who left without advice of doctors from January 1,2020 to September 30,2023 were retrospectively collected in acertain Tumor Hospital,and clinical information was collected for further analysis. Results:The against medical advice discharge rate is 0.2%. The average age of patients is 58.62,with males accounting for 59.9% slightly more than females(40.1%). the mean length of stay in hospital was 8.01 days. 265 patients(61.5%)were admitted for the first time. There were 379 malignant tumor patients(87.9%),of which 187(49.3%)experienced metastasis. Against medical advice discharge are more common in oncology departments(242,56.1%). The mainly malignant tumors are liver and gallbladder malignant tumors(38.8%),malignant neoplasm of bronchus and lung(14.8%),and pancreatic malignant tumors(7.9%). The exacutive rates for surgery,anti-tumor drug therapy,and radiotherapy are 59.6%,76.4% and 84.6%,respectively. The top four direct reasons are:personal subjective reasons refusing the treatment(36.4%),critical illness,family members abandonment(12.5%),refusal of medicine treatment such as radiotherapy and chemotherapy(12.1%),and abandonment of surgery and invasive procedures due to risk(11.6%). Conclusions:Against medical advice discharge is more common in the oncology department and first-hospitalized patients with a high mortality rate and poor prognosis cancer,and low adherence to treatment strategies,and it is the result of a combination of factors such as patients,diseases,and hospitals. This study provides a theoretical basis for the formulation of relevant intervention measures,which is of great significance for optimizing medical quality.