Analysis Of The Treatment Outcome And Standard Of Average Hospitalization Days Of Tuberculosis In A Hospital

ObjectivesTo improve the understanding of the characteristics of tuberculosis patients by comprehensively analyzing the characteristics and changing trend of the patients.To analysis and identify the important factors affecting the outcome of tuberculosis treatment by using correspondence analysis method and logistic regression model.To explore the standard of average hospitalization days based on the marginal hospitalization expense,and to provide a reference for the timely referral of the tuberculosis patients in hospital.Methods(1)Mean,percentile and constituent ratio were used to describe the variables about the patients,treatment process and outcome and their 10 years trend.Meanwhile,the changes of patients’ characteristics were compared before and after 5 years.(2)The influence factors of the outcome were analyzed by the correspondence analysis and logistic regression.In order to explore the changes of the internal relationship between the treatment outcome and the influencing factors,the above analysis was carried out respectively using data before and after 5 years.(3)Based on the data in recent three years,u test and general linear model were used to analyze the influencing factors of hospitalization expenses and hospitalization days.The average hospitalization days of tuberculosis,pulmonary tuberculosis and extrapulmonary tuberculosis were investigated by marginal cost method.Results(1)In the 2006-2013 years,the number of hospitalized TB cases increased year by year.In 2014,the number of hospitalized TB cases declined by 24%,and then remained stable.The cure rate and improvement rate of tuberculosis were kept at about 1.2% and 96%,respectively.Compared with those in the the previous five years,the proportion of women,45-60 years old,outpatients,extrapulmonary tuberculosis and general hospitalized patients increased in the last 5 years,and the cost of hospitalization increased significantly,while the length of stay was significantly shortened.(2)The results of the corresponding analysis showed that the hospitalization day was the most closely factor related to prognosis.As time goes on,the relationship between personal factors and hospitalization prognosis became weaker,but the relationship between the days of hospitalization and the outcome of treatment was always closely related.The results of logistic regression analysis before and after 5 years both showed that compared with the <10 day group,the ORs in other groups were less than 1,indicating that longer hospitalization days were favorable for positive outcome.The results of logistic regression analysis in the last five years showed that the OR value of the 20-30 day was the smallest and P<0.001,indicating that 20-30 days of hospitalization were most beneficial to the positive outcome of the treatment.(3)The hospitalization expenses kept rising trend from 2006 to 2012.In 2013,the hospitalization expenses had been greatly decreased and remained relatively stable after that.However,the hospitalization day was basically decreasing.The results of the analysis of the influencing factors of hospitalization expense and day showed that the hospitalization expense was higher for women and those who were over 60 years old,from local sources,at their own expense,in emergency,and in patients with critical illness,hematogenous disseminated tuberculosis and cured patients.The average expense of hospitalization for the cured patients was 38990 yuan,18005 yuan,and 3710 yuan higher than that of the improved,invalid,and dead patients.The results of the analysis of the influencing factors of hospitalization day showed that the hospitalization day was longer for those who were 45-60 years old,emergency hospitalization and critical condition,hematogenous disseminated tuberculosis and cured patients.The average day of hospitalization for the cured patients was 13 days,10.4 days and 14.9 days longer than that of the improved,invalid and dead patients.The most influential factor for hospitalization expense and hospitalization day was the treatment result.Based on the marginal hospitalization expense,the standard of average hospitalization day for tuberculosis,pulmonary tuberculosis and extrapulmonary tuberculosis was suggested to be 24 days,24 days and 19 days respectively.ConclusionThe changes in the characteristics of the patients in the last 10 years,on the one hand,indicated the effectiveness of the national tuberculosis prevention and control,and also suggested that the tuberculosis treatment in the general hospital was facing new problems.The results of correspondence analysis and logistic regression showed that the relationship between hospitalization days and treatment outcome was the most closely related,suggesting that we could start from the management of hospitalization days to improve the outcome of treatment.Based on the analysis of marginal hospitalization expenses,the standards of the average hospitalization day for tuberculosis,pulmonary tuberculosis and extrapulmonary tuberculosis were suggested to be 24 days,24 days and 19 days respectively.Since the marginal expense integrates the hospitalization expense and day,the standards of the average hospitalization days proposed in this study could provide a reference for the management of tuberculosis hospitalization days in hospitals,and promote TB patients’ timely referral.