基于大量数据的北京市冠心病患者费用研究  

Study of Expenses on Coronary Heart Disease in Beijing Based on Volume Data

作　　者：赵璇[1] 张晓溪[2] 谢其鑫[1] 赵丽颖[3] 蒋艳[3] 程薇[3] 

机构地区：[1]北京中医药大学基础医学院,北京100029 [2]中国中医科学院广安门医院,北京100053 [3]北京中医药大学管理学院,北京100029

出　　处：《中国卫生经济》2017年第9期63-68,共6页Chinese Health Economics

基　　金：国家中医药管理局重点学科"中医药管理学"资助项目(2013-ZDXKKF-17)

摘　　要：目的:以北京市37家三级医院冠心病患者为研究对象,深入了解冠心病费用现状以及影响因素,探讨费用合理区间,为疾病费用管理和控制提供参考。方法:采用方差分析、多元线性回归、决策树等方法。结果:(1)冠心病门诊和住院患者的平均年龄分别为65.23岁和67.47岁。(2)冠心病门诊患者次均费用为598.60元,其中药品费用占比为85.21%。(3)冠心病患者平均住院费用为25,422.06元,平均住院床日为8.35床日,费用主要以卫生材料费和药品费为主,合计占比超过70%。(4)住院天数、患者年龄、就诊医院、合并症以及并发症数目、性别是影响急性心肌梗死患者住院费用的主要因素。(5)以急性心肌梗死为例,构建决策树分组模型,最终分为13个病例组,各组间费用差异具有统计学意义。结论:加大冠心病防治力度,控制冠心病年轻化趋势。药品和卫生材料费是冠心病患者疾病负担的主要来源。需要通过缩短住院天数,重视疾病预防,推进临床路径管理等手段控制冠心病费用的过快增长。Objective： To analyze the general condition, medical expenses, influence factors of expenses on patients with coro- nary heart disease（CHD） in Beijing to provide references for management and control of disease expenses. Methods： One-way analysis of varianee（ANOVA）, multiple linear regression and decision tree analysis. Results： （1） The average ages of CHD outpatient and inpa- tient were 65.23 and 67.47 years old. （2） The average expenses of outpatients was 598.60 yuan per time, of which 85.21% was drug ex- penses. （3） The average expenses of inpatients was 25 422.06 yuan per time, of which more than 70% were expenses of drug and hy- gienic material. The average length of stay was 8.35 days. （4） Length of stay, age, hospital, number of complication and gender were the main factors influencing the expenses of inpatients with acute myocardial infaretion（AMI）. （5） The decision tree model divided the inpatients with AMI into 13 groups, and the expenses was different between each group. Conclusion： It needed to strengthen the pre- vention and treatment of CHD, control the trend of getting younger. The expenses of medicine and hygienic material were the main sources of disease burden in patients with CHD. By shortening length of stay, paying attention to disease prevention, and promoting clinical pathway were vital means to control excessive growth of CHD expenses.

关 键 词：冠心病 疾病费用 决策树 北京 

分 类 号：R197.323[医药卫生—卫生事业管理] R541.4[医药卫生—公共卫生与预防医学]