Cox回归模型在住院费用控制中的应用研究  

APPLIED STUDY ON COX REGRESSION MODEL IN HOSPITALIZATION EXPENSES CONTROL

作　　者：赵燕[1] 曹志辉[1] 李亚莉[1] 刘双元 郑贺英[3] 

机构地区：[1]华北煤炭医学院管理系,唐山063000 [2]河北省医疗保险基金管理中心 [3]华北煤炭医学院附属医院

出　　处：《现代预防医学》2008年第13期2448-2449,2456,共3页Modern Preventive Medicine

基　　金：河北省科技厅软科学研究项目(05457200)

摘　　要：[目的]探索造成高额住院费用的各种危险因素,为控制和降低医疗费用提供理论依据。[方法]以沧州市2004年出院的137名胆结石住院患者的病案首页信息为研究样本,采用多因素COX回归模型进行分析。[结果]模型中有统计学意义的变量有药费比例、住院天数、手术方式、有无医院感染、医院级别、年龄、有无次要诊断、入院时情况和付费方式。[结论]多因素Cox回归模型是探索高额住院费用危险因素的有效工具;针对药费比例、住院天数、手术方式、有无医院感染等可控危险因素采取必要的干预措施控制医疗费用;实施按病种付费,并按照入院时情况、疾病有无次要诊断等不可控因素制定不同的病种结算标准。[Objective] To explore all risk factors resulting in huge medical fees, and give some theoretical evidence to eontrol hospitalization expense. [ Methods] Medical record coverage of 137 inpatients with cholesterol gallstones in Cangzhou City in 2004, were sampled, and multivariate Cox regression model was used to analyze them. [ Results] Some factors with statistical significance were the proportion of drug fee in total hospitalization expense, hospitalization days, surgery type, hospital infection, hospital grade and level, age, secondary diagnosis, admission state and payment style. [ Conclusion ] Multivariate Cox regression model is effective to analyze risk factors resulting in huge medical fees. Some essential intervention measures aiming at controllable risk factors should be taken to decrease medical expense, including the proportion of drug fee in total hospitalization expense, hospitalization days, surgery type, hospital infection, and so on. Payment system basing on singledisease should be conducted, and according to some uncontrollable factors, different payment standard should be developed, such as admission state and secondary diagnosis.

关 键 词：住院费用 危险因素 

分 类 号：R195.1[医药卫生—卫生统计学]