Analysis Of Influential Factors On Length Of Stay For Single Disease In Henan's County Hospitals Based On Multi-Level Model

[Purpose] With the application of multi-level model, the research analyzed influential factors about length of stay for single disease in Henan's county hospitals. Factors about hospital characteristics and patients demographic characters were both considered. Normal delivery, cholelithiasis as well as hypertension were objectives of study. With the analysis of three hospitalization diseases, the study aimed to recognize the influential factor on length of stay for county hospital.[Methods]1. The research made literature review for qualitative data. We made summary about overseas and domestic research status. On the basis of 109 foreign literature and 3 English abstract, the research made conclusion on the association between hospital characters and medical service performance. Besides, we made reference on literature and thesis. The application of multi-level model had been summarized as well.2. The study made consultation from experts major in health management to identify indicators and index. The research invited 12 to 16 professors who had great achievements in health economic, health policy as well as medical quality and efficiency. According to the consultation from experts, the research built a framework for index about influential factors.3. Through on-site survey and collection of secondary data, we investigated basic information and admission records for 59 county hospitals in Henan province. With a stratified sampling, we sampled 59 county hospitals from 17 cities in Henan. With the help of the department of health planning and the information center, we collected statistical forms about 59 county hospital.4. We made status description about lenth of stay and hospitalization discharge with the application of office software and statistics technique. With the methods of one-way analysis of variance(ANOVA) and multi-level model, the study identified influencing factors on length of stay for county hospitals.[Results]1. With the analysis of medical record front sheets, the study calculated average length of stay and hospitalization discharge for common diseases in county hospitals. Delivery patients operated with cesarean section under lower uterine segment had an average length of stay for 6.8 days and average admission expense at 1713 Yuan. Patients suffered with cholelithiasis expended 5231 Yuan for the hospitalization and spent 9.36 days on the average. Patients diagnosed with hypertension took 9.31 days and costed 3715 Yuan averagely.2. The analysis of ANOVA reported that there had some factors made influence on length of stay for patients admitted with delivery, cholelithiasis and hypertension. Those common factors, such as, patients' age, gender, status of marriage, classification of medical insurance, admission department, condition of admission, disease outcome and cost of hospitalization, etc.3. The condition of patients admitted in hospital might have influence on length of stay. For patients hospitalized in county hospital, delivery patients and patients suffered with cholelithiasis as well as hypentation had a shorter Los when they admitted emergently. Besides patients with a heavey condition had a much longer Los. On the other hand, the treatment outcome made Los differ as well. Patients did not improve had a shorter Los. Patients' age range from 70 to 79 had a longer Los, especially for patients suffered with cholelithiasis and hypentation.4. The parameter estimation of covariance for empty model reported interclass correlation coefficient(ICC). We calculated ICC for delivery patients operated with cesarean section under lower uterine segment, patients hospitalized for cholecystolithiasis with cholecystitis and operated on cholecystectomy, hypertension patients at third stage admitted in internal medicine. And the ICC of case reports for three groups were all more than 10 percent. There had a nested structure for those data and they applied to multi-level model.[Conclusions]1. There had differently influential factors for various single disease. With the application of multi-level model, the study controlled influencing factors from hospital level. The analysis showed that disease outcome made Los differ, besides patients' age, medical insurance had influence on Los as well. Measured with single disease, hospital manager need to strengthen disease management and improve the efficiency of medical service.2. It was necessary to innovative approach for the analysis of Los. To improve the medical service in county hospital, hospital leaders need to strengthen management of single disease. Try to shorten the length of stay from controllable factors. Besides, combined with the disease spectrum in county hospital, we cound improve performance of medical service providing in county hospital with big data and data mining.3. The analysis reported that type of medical insurance was a crucially influencing factor for Los. And it had differences among various disease. Delivery patients with urban employee's basic medical insurance had a longer length of stay. Hospitalized patients diagnosed with cholelithiasis assisted with poverty assistance and hypentation patients paid all at his own expenses had longer Los as well.4. There had some demographic characteristics had influence on patients' length of stay for each disease. Patients' s age, gender, status of marriage etc. made Los different in some distance. The study made data statistics in county hospital. We identified factor which had influence on length of stay and analyzed the relationship between influential factor and Los. When we controlled factors from hospital lever, the report from a two-level linear regression decreased statistical errors.