Abstract: Background　Most of the community health centers（CHCs） in Shanghai have retained the system of hospital wards，which alleviates the problem of poor access to inpatient services to a considerable extent.However，how to deal with the patients having a long duration of hospitalization，and to improve the imbalance between insufficient inpatient services and residents' needs of inpatient services，have become the challenges faced by CHCs.Objective　To survey the number and disease profile of patients discharged from CHCs in Shanghai's rural-urban fringe.Methods　Data of 25 CHCs in Shanghai's Jiading District and Minhang District were collected in January 2017，including the number of doctors，number of serving people，and use of beds in 2016 obtained via a survey with these CHCs using a self-developed "Community Health Center Information Questionnaire"，and the diagnosis and hospitalization information of patients discharged in 2016 obtained via the health information management system.In the end，the data of 22 institutions was eligible and included.Results　In 2016，the 22 CHCs had 11 839 discharges in total.The bed rotation rate and occupancy rate were 3.86 and 85.96%，respectively.The average age of the discharged patients was（82.3±4.6） years old.The numbers of GPs and beds were associated with the number of discharges（P<0.05）.66.31%（7 851/11 839） of the discharged patients had at least 2 diagnoses.The top 3 principal diagnoses among these patients were cerebral infarction（n=1 117，9.43%），hypertension（n=698，5.90%） and coronary heart disease（n=661，5.58%）.Conclusion　In these CHCs，the majority of inpatients are old people，mostly have cardiovascular or cerebrovascular diseases，with a high prevalence of multimorbidity.The number of beds and GPs may influence the discharges.

Key words: Community health centers, Inpatients, Diagnosis, Disease constitution, Root cause analysis, Rural-urban fringe, Shanghai

摘要： 背景　上海市多数社区卫生服务中心保留了病房建制，在很大程度上缓解了居民“住院难”的问题，但其目前面临患者住院时间长、医疗供需不平衡等问题。目的　了解上海市城乡结合部社区卫生服务中心的出院人次和疾病构成情况。方法　于2017年1月，拟以上海市嘉定区和闵行区的25家社区卫生服务中心为研究对象。采用自行设计的“社区卫生服务中心服务内容调查表”收集2016年的医生数、服务人口数、床位使用情况；通过社区卫生服务中心信息管理（HIS）系统收集2016年的出院患者诊断和住院信息。最后纳入数据符合要求的22家社区卫生服务中心。结果　2016年22家社区卫生服务中心共计出院11 839人次，床位周转率为3.86，床位使用率为85.96%，出院患者的平均年龄为（82.3±4.6）岁。机构全科医生数和床位数是社区卫生服务中心病房出院人次的影响因素（P<0.05）。66.31%（7 851/11 839）出院患者的出院诊断≥2个。诊断人次排在前3位的第1诊断分别为脑梗死1 117人次（9.43%）、高血压698人次（5.90%）、冠心病661人次（5.58%）。结论　社区卫生服务中心住院患者以老年人居多，心脑血管疾病等慢性病为主，多病共存现象普遍；机构床位数和全科医生数会影响病房的出院人次。

关键词: 社区卫生中心, 住院病人, 诊断, 疾病构成, 影响因素分析, 城乡结合部, 上海