fa کاربرد مدل چندسطحی در تعیین عوامل موثر بر طول مدت اقامت بیماران آپاندکتومی آمار حیاتی Biostatistics پژوهشي Research <font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">زمینه و هدف</span></b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">:</span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"> با توجه به محدودیت‌های مراکز درمانی و بیمارستان در سطح کشور، توجه به طول مدت اقامت بیمار در بیمارستان اهمیت پیدا می‌کند. هدف از این پژوهش بررسی عوامل موثر بر طول مدت اقامت بیماران آپاندکتومی در بیمارستان‌های تامین اجتماعی کشور با استفاده از مدل چند سطحی است.<o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">روش کار</span></b><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">: این مطالعه از نوع مقطعی- تحلیلی است که ارتباط بین طول مدت اقامت بیماران آپاندکتومی و متغیرهای</span><span dir="ltr"></span><span lang="FA" style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"><span dir="ltr"></span> </span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">سن، جنس، نوع بیمه بیمار و تعداد تخت فعال بیمارستان را مورد بررسی قرار می‌دهد. اطلاعات کلیه 570 بیمار که در 6 ماهه اول سال 1388 در<font size="2"><font face="B Mitra"><span style="mso-spacerun: yes"> </span>بیمارستان‌های تامین اجتماعی کشور برای آپاندکتومی بستری شدند از سیستم </font></font></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">HIS</span><span dir="rtl"></span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> بیمارستان‌ها استخراج شد. برای تحلیل داده‌ها از روش آماری رگرسیون سه سطحی استفاده گردید. تحلیل داده‌ها و برازش مدل در نرم‌افزار </span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">SAS</span><span dir="rtl"></span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span><font size="2"><font face="B Mitra"><span style="mso-spacerun: yes"> </span>نسخه 9.1 اجرا گردید.<o:p /></font></font></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">یافته‌ها</span></b><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">: میانگین طول مدت اقامت بیماران آپاندکتومی4/2 روز بود. جنسیت، سن، نوع بیمه بیمار و تعداد تخت فعال بیمارستان، تاثیری در طول مدت اقامت بیماران آپاندکتومی نداشت (05/0</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">p></span><span dir="rtl"></span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span>).<font size="2"><font face="B Mitra"><span style="mso-spacerun: yes"> </span>اثر تصادفی بیمارستان بر طول مدت اقامت بیماران معنادار است (003/0</font></font></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">p=</span><span dir="rtl"></span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span>)، یعنی مدت اقامت بیماران در بیمارستان‌های مختلف متفاوت است ولی بین طول مدت اقامت بیماران استان‌های مختلف اختلاف معناداری وجود ندارد و واریانس بین استان‌ها معنی دار نیست (302/0</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-language: FA mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">p =</span><span dir="rtl"></span><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span>).<o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">نتیجه‌گیری</span></b><span lang="FA" style="font-family: "B Mitra" font-size: 10pt mso-bidi-language: FA mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">: در نظر گرفتن وابستگی میان داده‌ها و استفاده از مدل رگرسیون چند سطحی منجر به یافتن اثر تصادفی بیمارستان گردید که نشان می دهد بیمارستانی که بیمار در آن بستری می شود بر مدت اقامت بیماران تاثیر دارد و استفاده از مدل چندسطحی این تفاوت را آشکار می کند. <o:p /></span></p><font face="Times New Roman" size="3"> </font> <font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-indent: 0.7pt text-justify: kashida text-kashida: 0%"><b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">Background: </span></b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">Because of the limitations concerning health centers and hospitals in Iran, the length of stays at the hospitals is of high importance. The purpose of this research is to investigate the factors affecting the length of stay among appendectomy patients at Social Security Organization hospitals using a multilevel model.<b><o:p /></b></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="background: white margin: 0in 0in 0pt text-align: justify line-height: normal text-indent: 0.7pt text-justify: kashida text-kashida: 0%"><font style="background-color: rgb(255, 255, 255)"><b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">Methods</span></b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">: We presented an applied-analytical study which investigated the relation between length of stay among appendectomy patients at Social Security Organization hospitals and variables namely, age, gender, type of insurance and the inpatient bed count at hospital. </span><span style="font-family: "Times New Roman","serif" font-size: 12pt">The information of patients who were hospitalized in hospitals for appendectomy during the first 6 months of 2009, were gathered from </span><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">HIS system of the hospitals. The three-level regression statistical method was used to analyze the data. All </span><span style="background: white font-family: "Times New Roman","serif" font-size: 12pt">analyses were conducted in SAS 9.1 software.</span></font><span lang="FA" style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA" dir="rtl"><o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-indent: 0.7pt text-justify: kashida text-kashida: 0%"><b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">Results</span></b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">: The findings show that the average length of stay among patients was 2.4 days and gender, age, type of insurance and the number of inpatient bed count at the hospital had no effect on the length of stay at hospital. The results also indicated that there is a significant difference between the lengths of stay in different hospitals but no significant difference was observed between different provinces.<span lang="FA" dir="rtl"><o:p /></span></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-indent: 0.7pt text-justify: kashida text-kashida: 0%"><b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">Conclusion</span></b><span style="font-family: "Times New Roman","serif" font-size: 12pt mso-bidi-language: FA">: Considering the dependence between the data and using the multi-level regression model led to concluding the significant difference between the length of stay in different hospitals.<o:p /></span></p><font face="Times New Roman" size="3"> </font> رگرسیون چندسطحی، طول مدت اقامت، آپاندکتومی، بیمار بستری Multilevel regression, Length of stay, Appendectomy, Inpatient 70 77 http://rjms.iums.ac.ir/browse.php?a_code=A-10-1-1491&slc_lang=fa&sid=1 Marzieh mohamadali Noruzi مرضیه محمدعلی نوروزی 3900319475328460025065 3900319475328460025065 No Tehran University of Medical Sciences دانشگاه علوم‌پزشکی تهران Agha Fatemeh Hosseni آغافاطمه حسینی 3900319475328460025066 3900319475328460025066 No Iran University of Medical Sciences دانشگاه علوم پزشکی ایران Mahmood Reza Gohari محمودرضا گوهری 3900319475328460025067 3900319475328460025067 Yes Iran University of Medical Sciences دانشگاه علوم پزشکی ایران