Under the government's great concern and support to the development of general practice, general practice departments have been successively set up in general hospitals. The disciplinary characteristics of general practice has significant advantages in the treatment management of chronic disease and symptoms of an unknown etiology. However, the treatment and management of chronic disease and symptoms of an unknown etiology in the general medicine ward of tertiary comprehensive hospitals is currently unclear.

This study aims to analyze the current situation and management of chronic disease and symptoms of an unknown etiology in the general medicine ward of a tertiary comprehensive hospital, to analyze the existing problems, and explore the direction of continuously improving the management quality and efficiency of the general medicine department.

Taking the general medical ward of Beijing Friendship Hospital, Capital Medical University as an example, the clinical data of all the inpatients since the establishment of the general medical ward of the hospital (from November 2019 to January 2024) were extracted through the electronic medical record system in February 2024. The general conditions, admission sources, discharge diagnoses and prognosis of the participants were analyzed retrospectively.

A total of 2 725 cases included in the study. The ages ranged from 12 to 95 years old, with the average age of (57.4±15.8) years old, including 1 400 (51.38%) patients aged 60 years and older. The median (quartile) hospitalization time was 7 (5, 9) days and the median (quartile) hospitalization cost was 9 053.71 (6 551.53, 12 380.82) yuan. 1 724 cases (63.27%) were admitted from general outpatient clinics and 1 001 cases (36.73%) were transferred from emergency department or specialties. The top three diseases with the largest number of hospital visits were acute pancreatitis (9.06%, 247/2 725), abdominal pain (7.41%, 202/2 725) and pneumonia (7.30%, 199/2 725), respectively. A total of 1 899 (69.69%) patients suffered from chronic diseases, 1 085 (39.81%) patients had multiple diseases coexisting and 1 016 (37.18%) patients had polypharmacy. 1 658 patients (60.84%) had a clear diagnosis at admission and 1 067 patients (39.16%) were admitted with one or more symptoms of an unknown etiology. The top three symptoms of an unknown etiology with the largest numbe of hospital visits were abdominal pain (7.41%), dizziness (5.43%) and abdominal distension (5.03%), respectively. The top five systems ranked as the main discharge diagnosis were digestive system in 1 166 cases (42.79%), respiratory system in 334 cases (12.26%), endocrine system in 317 cases (11.63%), cardiovascular system in 279 cases (10.24%) and blood system in 176 cases (6.46%), respectively. The top ten most diagnosed cases were 249 cases (9.14%) of acute pancreatitis, 238 cases (8.73%) of pneumonia, 220 cases (8.07%) of chronic gastritis, 175 cases (6.42%) of type 2 diabetes with chronic complications, 174 cases (6.39%) of acute cholecystitis, 154 cases (5.65%) of malignant tumors, 109 cases (4.00%) of hypertension, 73 cases (2.68%) of coronary atherosclerotic heart disease, 62 cases (2.28%) of colorectal polyps and 59 cases (2.17%) of thyroid nodules. 2 411 cases (88.48%) were cured and discharged and 96 cases (3.52%) were transferred to specialist departments due to definite specialist diseases were diagnosed. The hospitalization costs of patients with symptoms of an unknown etiology were higher than those with definite diagnosis at admission (P<0.05), and there was no statistical difference in the hospitalization time (P>0.05). The hospitalization time and costs of patients with chronic diseases were higher than those without chronic diseases (P<0.05). The hospitalization time and costs of patients with multiple coexisting diseases were higher than those without multiple coexisting diseases (P<0.05) .

Inpatients in the general medicine department of the tertiary general hospital cover a wide range of ages. The disease spectrum involves common diseases in multiple systems, chronic diseases and symptoms of an unknown etiology. The coexistence of multiple diseases is common. Thus the general medicine ward meets the basic medical needs of patients. General medicine is closely related to grassroots health institutions, emergency departments and specialties, which is of great significance in the graded diagnosis and treatment of chronic diseases and symptoms of an unknown etiology, as well as in the multidisciplinary diagnosis and treatment. The long length of hospital stay and high hospitalization costs of patients with chronic diseases, symptoms of an unknown etiology and multiple coexisting diseases suggest that general practitioners need to continuously refine management processes and service content in the management process of chronic diseases and symptoms of an unknown etiology as well as continuously improve management quality.

在政府对全科医学发展的高度重视下，三级综合医院陆续设置全科医学科，全科医学科的学科特色使其在慢性病及不明病因症状的收治与管理中具有明显优势。然而，慢性病及不明病因症状在三级甲等综合医院全科医学科病房的收治及管理情况尚不清楚。

了解三级甲等综合医院全科医学科病房收治慢性病及不明病因症状情况，分析其中存在的问题，探索持续提升全科医学科管理质量与效率的方向。

以首都医科大学附属北京友谊医院全科医学科病房为例，于2024年2月通过电子病历系统提取全科医学科病房建立以来（2019年11月—2024年1月）所有住院患者的临床资料，回顾性分析患者的一般情况、入院来源、入院诊断、住院诊治、出院诊断及转归情况。

共纳入2 725例次住院患者，年龄为12~95岁，平均年龄为（57.4±15.8）岁，≥60岁患者1 400例次（51.38%），中位住院天数为7（5，9）d，中位住院费用为9 053.71（6 551.53，12 380.82）元。由全科门诊收入1 724例次（63.27%），由急诊科或专科转入1 001例次（36.73%）。入院诊断占比最高的前3位疾病依次是急性胰腺炎（9.06%，247/2 725）、腹痛待查（7.41%，202/2 725）、肺炎（7.30%，199/2 725）。1 899例次（69.69%）患者患有慢性病，1 085例次（39.81%）患者有多病共存现象，1 016例次（37.18%）患者存在多重用药。1 658例次（60.84%）患者入院时诊断明确，1 067例次（39.16%）患者以不明病因症状入院。入院诊断占比最高的前3位不明病因症状依次是腹痛待查（7.41%）、头晕待查（5.43%）、腹胀待查（5.03%）。出院主要诊断所在系统排序前5位依次为消化系统1 166例次（42.79%）、呼吸系统334例次（12.26%）、内分泌系统317例次（11.63%）、心血管系统279例次（10.24%）、血液系统176例次（6.46%），主要诊断病例数排在前10位的依次是急性胰腺炎249例次（9.14%）、肺炎238例次（8.73%）、慢性胃炎220例次（8.07%）、2型糖尿病伴慢性并发症175例次（6.42%）、急性胆囊炎174例次（6.39%）、恶性肿瘤154例次（5.65%）、高血压109例次（4.00%）、冠状动脉粥样硬化性心脏病73例次（2.68%）、结直肠息肉62例次（2.28%）、甲状腺结节59例次（2.17%）。2 411例次（88.48%）患者经全科住院诊治后好转出院，96例次（3.52%）患者诊断明确后因需专科治疗转入相应专科。以不明病因症状入院患者的住院费用高于入院时诊断明确的患者（P<0.05），两组住院天数比较，差异无统计学意义（P>0.05）；患有慢性病者的住院天数和住院金额均高于未患慢性病者（P<0.05）；多病共存患者的住院天数和住院费用均高于非多病共存患者（P<0.05）。

北京市三级甲等综合医院全科医学科病房住院患者年龄范围广，≥60岁患者占多数，疾病谱涉及多个系统的常见病、慢性病及不明病因症状，多病共存及多重用药现象常见，医疗工作符合全科医疗诊疗方向。全科医学科与基层医疗卫生机构及医院急诊、专科联系紧密，在慢性病及不明病因症状的分级诊疗及多学科诊治中有重要意义。慢性病、不明病因症状及多病共存患者的住院天数长、住院费用高，提示全科医生在慢性病及不明病因症状管理过程中需不断细化管理流程和服务内容，不断提升管理水平和质量。