姑息治疗对恶性肿瘤死亡病人住院费用变化的影响分析  

The Impact of Palliative Care on Charges of Cancer Patients Died in Hospital

作　　者：陈萌蕾 成文武 

机构地区：[1]复旦大学附属肿瘤医院姑息治疗科 [2]复旦大学上海医学院肿瘤学系,200032

出　　处：《中国卫生统计》2012年第5期642-645,649,共5页Chinese Journal of Health Statistics

摘　　要：目的了解姑息治疗科成立后恶性肿瘤死亡病人基本特征及住院费用的变化,探讨姑息治疗科在该变化中所起的作用。方法回顾性收集2004年9月-2009年8月医院死亡病例共690例,比较姑息治疗科与全院非姑息科室病人资料,以及姑息治疗科成立前后全院病人资料,采用路径分析了解姑息治疗科在费用变化中所起的作用。结果与非姑息科室相比,姑息治疗科死亡病人年龄较大,KPS评分较低,住院天数较短,较少使用化疗、放疗和手术等治疗方式。同期比较,姑息治疗科总费用低于非姑息科室(例均38.83%,日均20.79%),全院总费用亦低于非姑息科室(例均17.53%,日均8.67%),降幅较大者均为西药费和总治疗费,中药费则明显增加。前后比较,姑息治疗科成立后,非姑息科室日均总费用增加15.65%,但姑息治疗科仍较其成立前非姑息科室总费用下降34.04%。控制其他因素后,姑息治疗科作为直接和/或间接影响因素降低日均总费用。结论恶性肿瘤患者中老年和/或一般情况较差及倾向于中药治疗者更多选择姑息治疗。姑息治疗可在一定程度上降低恶性肿瘤临终病人的住院费用,并在合理范围内减少用药及治疗。Objective To evaluate the variation of characteris- tics and hospital charges of cancer patients who died after the establishment of a palliative care unit （PCU）. And determine the impact of PCU on it. Methods The demographic and clinical characteristics and hospital char- ges of 690 cancer patients who died in Fudan University Shanghai Cancer Center were obtained retrospectively from September 2004 to August 2009. We compared the data of cancer patients died in PCU to non-PC units（ non- PCUs） and pre- to post- establishment of PCU all over the hospital. Path a- nalysis was estimated for the impact of PCU on the variation of total char- ges. Results Compared with non-PCUs,PCU was associated significant- ly with older patients,lower Karnofsky Performance Scale, shorter length of stay and less likelihood to have chemotherapy, radiotherapy and surgery. Total charges for PCU patients were 38. 83% lower per admission and 20.79% lower per hospital day than charges for nonrPCUs in the same pe- riod, including significantly reductions in western medicine and treatment charges , as well as increase in Chinese medicine charges. Similar results were observed in the comparison between total charges for the whole hospi- tal and for non-PCUs after the establishment of PCU （per admission 17.53% lower; per day 8.67% lower）. Total charges for non-PCUs pa- tients were increased 15.65% per day from pre-establishment to post-estab- lishment of PCU. However, total charges for PCU were significantly re- duced 34. 04% per admission compared with non-PCUs before the estab- lishment of PCU. As other factors controlled, PCU directly and/or indirect- ly reduced total charges per day. Conclusion Cancer patients with elder age, poor performance status and/or tendency to traditional Chinese medi- cine are more likely to choose palliative care. Palliative care for cancer pa- tients died in hospital results in lower hospital charges and less utilization of western medicine and treatment.

关 键 词：姑息治疗 住院费用 路径分析 临终 

分 类 号：R73-31[医药卫生—肿瘤]