某三甲医院住院患者分类及费用影响因素分析  

Inpatient Classification and Analysis of the Influential Factors of Hospitalization Expense in a Grade A Tertiary Hospital

作　　者：杨晓妍[1] 王觅也 张睿[1] 李楠[1] 师庆科[1] 黄勇[1] 

机构地区：[1]四川大学华西医院信息中心,成都610041

出　　处：《中国循证医学杂志》2015年第11期1246-1253,共8页Chinese Journal of Evidence-based Medicine

基　　金：国家"863"计划项目(编号:2012AA02A615);国家科技支撑计划项目(编号:2012BAH07F05)

摘　　要：目的了解住院患者分类及费用影响因素,为医院管理提供依据。方法收集某三甲医院2013年全年住院患者诊疗数据,用百分位数描述住院费用分布情况,用K-均值聚类法进行患者分类,用秩和检验分析各类患者费用差异,用ICD-10进行病种分析,用中位数回归分析住院费用的影响因素。结果该院全年住院患者175 333人次,总费用中位数10 016.31元。患者可分为7类,各类患者住院总费用之间存在统计学差异(P=0.000 1)。对无"输血费用"患者,影响患者分类的前三位费用类别为手术、化验、诊察费用;对有"输血费用"患者,影响患者分类的前三位费用类别为输血、化验、诊察费用。7类患者ICD-10亚目病种数分别为2 147、2 182、1 499、1 301、2 059、22和14种。影响住院总费用的因素可概括为患者相关和诊治相关两类。结论手术、输血、化验和诊察费用是影响住院患者分类的主要因素。研究结果可为患者收治、费用控制和病种管理提供参考。Objective To understand the inpatient classification and influence factors of hospitalization expenses, so as to provide basis for hospital management. Methods The diagnosis and treatment data of inpatients in a grade A tertiary hospital in 2013 were collected, the percentile method were used to describe the expenses distribution, the K-means clustering method was applied to classify the inpatients, the rank-sum test was utilized to analyze the differences of the costs among different groups, ICD-10 was applied to analyze the diseases distribution, and the median regression was used to analyze the influence factors. Results There were 175 333 inpatients in total. The median of the expenses was 10 016.31 yuan RMB. The inpatients might be classified into seven groups with different expenses （P=0.000 1）. For inpatients who had no ＂blood transfusion cost＂, the top three factors of cost category were operation, laboratory test, examination; for who had ＂blood transfusion cost＂, the top three factors of cost category were blood transfusion, laboratory test, examination. There were 2 147, 2 182, 1 499, 1 301, 2 059, 22 and 14 kinds of diseases （ICD-10 four-digit code） respectively among the seven groups. The influence factors could be summarized into patient-related and diagnosis ＆ treatment-related ones. Conclusion The costs of operation, blood transfusion, laboratory test, and examination affect the inpatients classification greatly. The results could be of help to inform the admission of patients, the expense control and the disease management.

关 键 词：医院信息系统(HIS) 住院费用 数据挖掘 医院管理 ICD-10 

分 类 号：R197.32[医药卫生—卫生事业管理]