依据抗菌药物使用强度和病例组合指数的多院区精细化管理研究 点击下载
| 论文标题： | 依据抗菌药物使用强度和病例组合指数的多院区精细化管理研究 |
| 英文标题： | |
| 中文摘要： | 目的 为多院区医疗机构抗菌药物精细化管理提供科学依据与实践参考。方法收集2023年8月－2026年3月我院利济路主院区和盘龙城分院区住院患者抗菌药物使用强度（AUD）数据，以及各医师及其所在病区的病例组合指数（CMI）数据。运用两因素分解法将总AUD变动分解为水平效应与结构效应；通过灰色关联分析（GRA）量化病区CMI、医师CMI与医师AUD的关联度，定位需要重点干预的病区和医师。依托上述分析结果，构建并实施一院多区抗菌药物精细化管控方案，同时采用中断时间序列（ITS）模型，纳入季节虚拟变量，对比干预前（2023年8月－2024年3月）、后（2024年4月－2026年3月）两院区AUD的时间变化趋势，评价管控成效。结果影响两院区AUD变动的因素存在明显差异：主院区的AUD变动由水平效应主导，分院区的AUD变动由结构效应和水平效应共同推动。病区CMI、医师CMI与医师AUD的关联度分别为0.901和0.882。实施精细化管控措施后，主院区、分院区AUD分别即时下降7.48、20.54DDDs/（100床·日），且两个院区AUD变化趋势均由上升变为下降。结论一院多区模式下AUD变动的驱动因素具有院区异质性；CMI与AUD高度相关。基于AUD归因分解和CMI关联分析建立的精细化管理模式，可匹配一院多区的差异化诊疗特征，有效提升抗菌药物管控的精准性。 |
| 英文摘要： | OBJECTIVE To provide scientific evidence and practical references for refined antimicrobial stewardship in multi- branch medical institutions. METHODS Data of antibiotic use density （AUD） of inpatients as well as physician-level case mix index （CMI） were collected from the Liji Road main campus and Panlongcheng branch campus of our hospital from August 2023 to March 2026. The two-factor decomposition method was adopted to decompose total AUD variation into a level effect and structural effect. Grey relational analysis （GRA） was performed to quantify the correlation degree between ward CMI， physician CMI and physician AUD， so as to identify wards and physicians requiring targeted key intervention in different campuses. A refined antimicrobial management framework for multi-branch hospitals was constructed and implemented based on the above analytical results. An interrupted time series （ITS） model incorporating seasonal dummy variables was applied. The research period was divided into pre-intervention stage （August 2023 to March 2024） and post-intervention stage （April 2024 to March 2026）. The temporal changing trends of AUD in two campuses were compared to evaluate management efficacy. RESULTS Driving factors for AUD variation presented significant heterogeneity between the two campuses. AUD variation in the main campus was dominated by level effect， while AUD variation in the branch campus was jointly affected by structural effect and level effect. The grey relational degrees of ward CMI and physician CMI with physician AUD were 0.901 and 0.882， respectively. After refined management implementation， AUD decreased by 7.48 DDDs/（100 bed·days） and 20.54 DDDs/（100 bed·days） in the main campus and branch campus， respectively； the rising trends of AUD in both campuses reversed to declining trends after intervention. CONCLUSIONS Driving factors of AUD variation under the multi-branch hospital model show obvious inter-campus heterogeneity. CMI is highly correlated with AUD. The refined management system developed via AUD attribution decomposition and CMI correlation analysis matches the differentiated clinical characteristics of multi- branch hospitals and effectively improves the precision of antimicrobial stewardship. |
| 期刊： | 2026年第37卷第15期 |
| 作者： | 杨香瑜；李璐璐；余子珩；张韶辉 |
| 英文作者： | YANG Xiangyu，LI Lulu，YU Ziheng，ZHANG Shaohui |
| 关键字： | 抗菌药物使用强度；一院多区；病例组合指数；灰色关联分析；中断时间序列；精细化管理 |
| KEYWORDS： | antibiotic use density； multi-branch hospital； |
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