探讨2020—2025年上海市不同类别医疗机构儿童社区获得性肺炎(CAP)单病种质控指标的监测结果变化趋势。

选择2020年1月1日至2025年12月31日上海市102家医疗机构收治的儿童CAP单病种质控指标(儿童CAP出院例数、重症CAP住院比例、病情严重程度评估率、抗菌药物使用率、机械通气率、输血率、住院死亡率、平均住院日、住院次均费用及住院次均药费10项)的6年监测结果为研究对象。对102家医疗机构按照医疗机构类别进行分层，包括A类(n＝44，三级综合医院)，B类(n＝35，二级综合医院)，C类(n＝3，三级儿童专科医院)，D类[n＝20，其他医疗机构(中医医院、妇幼保健机构、传染病及公共卫生机构等)]，分别提取上海市医疗服务监测与评价系统中关于这4类医疗机构的儿童CAP质控指标的6年监测结果，并分析其年度变化特征。对于4类医疗机构的重症CAP住院比例、病情严重程度评估率等计数资料采用百分比(%)表示，并采用Cochran-Armitage趋势检验，分析这4类医疗机构的上述指标年度变化趋势；对于儿童CAP平均住院日、住院次均费用及住院次均药费等定量资料以平均值表示，并进行描述性年度变化特征分析。

① 2020—2025年，上海市102家医疗机构共纳入儿童CAP出院病例为183 307例，A、B、C、D类占比分别为49.25%(90 279/183 307)、16.89%(30 961/183 307)、33.08%(60 632/183 307)、0.78%(1 435/183 307)。4个类别机构中，C类收治的重症CAP住院患儿比例最高，A、B、C类收治的重症CAP住院患儿比例均呈下降趋势，并且变化趋势比较，差异有统计学意义(Z＝－8.93、－2.84、－4.64，P<0.05)。② A、B、C、D类医疗机构儿童CAP病情严重程度评估率总体改善，年度变化趋势比较，差异均有统计学意义(Z＝21.61、21.76、25.76、10.73，P<0.001)；C类的抗菌药物使用率呈下降趋势，B、D类呈升高趋势，年度变化趋势比较，差异均有统计学意义(Z＝－36.84、19.36、15.51，P<0.001)。③儿童CAP机械通气率在C类总体高于其他3类机构，但是呈下降趋势(Z＝－4.40，P<0.001)，A类呈先升后降变化趋势(Z＝－3.08，P＝0.002)；A、C类的儿童CAP输血率均呈下降趋势(Z＝－9.56、－21.28，P<0.001)。④4类医疗机构的儿童CAP住院死亡率总体处于较低水平，其中A、B、C类的住院死亡率呈下降趋势(Z＝－17.64、－1.97、－4.62，P<0.05)；平均住院日总体呈缩短趋势，A、C类下降较为明显。A、C类的儿童CAP住院次均费用和住院次均药费总体呈下降趋势，B、D类的年度间波动较明显。

2020—2025年，上海市儿童CAP单病种质控指标的监测结果总体呈改善趋势，已形成较为明确的分层收治格局。A类承担儿童CAP主要收治任务，C类在重症CAP患儿的救治中发挥重要作用。未来应结合医疗机构功能定位，完善儿童CAP单病种的分层质控和信息化管理体系，进一步提升区域儿童CAP诊疗质量和管理水平。

To investigate trends in the monitored single-disease quality-control indicators for pediatric community-acquired pneumonia (CAP) across different categories of medical institutions in Shanghai from 2020 to 2025.

Six-year monitoring data on 10 single-disease quality-control indicators for pediatric CAP were collected from 102 medical institutions in Shanghai between January 1, 2020, and December 31, 2025. The indicators included the number of pediatric CAP discharges, proportion of severe CAP cases among hospitalized patients, severity assessment rate, antibiotic use rate, mechanical ventilation rate, blood transfusion rate, in-hospital mortality rate, average length of stay, average hospitalization cost per case, and average medication cost per case. The 102 medical institutions were stratified into four categories: category A (n=44, tertiary general hospitals), category B (n=35, secondary general hospitals), category C (n=3, tertiary children′s specialty hospitals), and category D (n=20, other medical institutions, including traditional Chinese medicine hospitals, maternal and child health institutions, infectious disease hospitals, and public health institutions). Six-year monitoring data for the four categories were extracted from the Shanghai Medical Service Monitoring and Evaluation System, and their annual changes were analyzed. Proportion indicators, including the proportion of severe CAP cases among hospitalized patients and the severity assessment rate, were expressed as percentages and analyzed using the Cochran-Armitage trend test. Quantitative indicators, including average length of stay, average hospitalization cost per case, and average medication cost per case, were expressed as means and analyzed descriptively for annual changes.

① From 2020 to 2025, a total of 183 307 pediatric CAP discharge cases were included from 102 medical institutions in Shanghai. Patients from categories A, B, C, and D institutions accounted for 49.25% (90 279/183 307), 16.89% (30 961/183 307), 33.08% (60 632/183 307), and 0.78% (1 435/183 307), respectively. The proportion of severe CAP cases among hospitalized patients was highest in category C institutions. This proportion decreased significantly in categories A, B, and C institutions (Z=-8.93, -2.84, and -4.64, respectively; all P<0.05). ② The severity assessment rate improved overall across all four categories institutions, with statistically significant annual trends (Z=21.61, 21.76, 25.76, and 10.73, respectively; all P<0.001). The antibiotic use rate decreased in category C institutions but increased in categories B and D, with statistically significant annual trends (Z=-36.84, 19.36, and 15.51, respectively; all P<0.001). ③ The mechanical ventilation rate was generally higher in category C institutions than in the other three categories institutions but showed a decreasing trend (Z=-4.40, P<0.001). Category A institutions showed an increase followed by a decrease (Z=-3.08, P = 0.002). Blood transfusion rates decreased in categories A and C institutions (Z=-9.56 and -21.28, respectively; both P<0.001). ④ In-hospital mortality remained low overall across the four categories and decreased in categories A, B, and C institutions (Z=-17.64, -1.97, and -4.62, respectively; all P<0.05). Average length of stay shortened overall, with more pronounced reductions in categories A and C institutions. Average hospitalization cost per case and average medication cost per case generally decreased in categories A and C institutions, whereas more marked year-to-year fluctuations were observed in categories B and D institutions.

From 2020 to 2025, the monitored single-disease quality-control indicators for pediatric CAP in Shanghai showed an overall improving trend, and a relatively clear stratified admission pattern was observed. Category A institutions undertook the largest share of pediatric CAP admissions, whereas category C institutions played an important role in the management of severe pediatric CAP. Future quality-control efforts should consider the functional roles of different medical institutions, improve the stratified quality-control and information technology-enabled management systems for pediatric CAP, and further enhance the quality and management of regional pediatric CAP care.