上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（公共卫生） • 上一篇    下一篇

上海市老年护理院出入院标准试运行研究

张杰1，李国红1,杨颖华2,王盟1   

  1. 1.上海交通大学 公共卫生学院， 上海 200025； 2.上海市人口和计划生育宣教中心， 上海 200125
  • 出版日期:2016-04-28 发布日期:2016-05-26
  • 通讯作者: 李国红, 电子信箱: guohongli@sjtu.edu.cn。
  • 作者简介:张杰（1980—）， 男， 硕士生; 电子信箱: zhangjie8822@sjtu.edu.cn。

Trial implementation of Admission and Discharge Criteria for Geriatric Nursing Homes in Shanghai

ZHANG Jie1, LI Guo-hong1, YANG Ying-hua2, WANG Meng1   

  1. 1.School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China; 2.Education Center of Shanghai Population and Family Planning, Shanghai 200125, China
  • Online:2016-04-28 Published:2016-05-26

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摘要：

目的 结合国内外地区经验和国内具体情况，拟定《上海市老年护理院出入院标准》并评估其真实性与可行性。方法 通过文献综述、问卷调查及专家访谈拟定《上海市老年护理院出入院标准》，并将该标准转换成系统软件。对上海地区26家老年护理机构中的住院患者进行医师评估和软件系统评估，分析标准评估与医师评估结果的一致性，并计算标准评估的敏感度和特异度。分析上海地区老年护理机构住院患者人群分布特点。结果 Kappa一致性检验显示，标准评估结果与医师评估结果Kappa值为0.931（P=0.006）。以医师评估为金标准，计算标准评估敏感度和特异度，分别为98.40% （95%CI98.03%～98.76%）和96.20% （95%CI 95.15%～97.26%）。对上海地区老年护理机构住院患者人群分布特点进行分析，结果显示，应当出院或转院但仍住院的老年患者中郊区患者比例高于市区（P=0.000），通过社保支付的患者比例明显高于其他支付方式（P=0.016），干部人群比例明显高于其他职业人群（P=0.004）；独立社区卫生中心收治符合标准的患者情况最佳，达到84.1%。分析住院患者罹患疾病，发现糖尿病患者不符合住院标准者比例最高，达32.4％。结论《上海市老年护理院出入院标准》能较真实、客观、有效地评价上海地区老年患者是否符合老年护理院出入院标准

关键词: 老年护理院, 出入院, 标准

Abstract:

Objective To prepare and assess the authenticity and feasibility of Admission and Discharge Criteria for Geriatric Nursing Homes in Shanghai according to experiences both at home and abroad and domestic status. Methods Admission and Discharge Criteria for Geriatric Nursing Homes in Shanghai was prepared via literature review, questionnaire survey, and expert interview and converted to a system software. Inpatients in 26 geriatric nursing homes in Shanghai were assessed by physicians and the software system. The consistency between criteria assessment and physician assessment was analyzed and the sensitivity and specificity of criteria assessment were calculated. Characteristics of inpatient population distribution in geriatric nursing homes in Shanghai were analyzed. Results Kappa consistency test showed that the Kappa value of criteria assessment and physician assessment results was 0.931 (P=0.006). The sensitivity and specificity of the criteria assessment were 98.40% (95%CI98.03%-98.76%) and 96.20% (95%CI95.15%-97.26%) taking the physician assessment as a gold standard. Analysis of the characteristics of inpatient population distribution in geriatric nursing homes in Shanghai showed that more elderly patients in suburb areas should be discharged or transferred but still remained hospitalized as compared with those in urban areas (P=0.000). The proportion of patients using social insurance was higher than those using other payment methods (P=0.016). The proportion of cadre population was significantly higher than other populations (P=0.004). The proportion of eligible patients admitted by independent community health centers was the highest (84.1%). The proportion of ineligible patients with diabetes was the highest (32.4%). Conclusion Admission and Discharge Criteria for Geriatric Nursing Homes in Shanghai can truly, objectively, and effectively assess whether elderly patients in Shanghai are eligible for the admission and discharge criteria for geriatric nursing homes.

Key words: nursing homes, admission and discharge, standard