边际分析法评估脑卒中手术患者医院感染经济负担  

Assessment of economic burden of stroke surgery patients due to nosocomial infection based on marginal analysis

作　　者：宋甜田 李亚婷[1,2] 杜金阁 孟葳 王书会 SONG Tian-tian;LI Ya-ting;DU Jin-ge;MENG Wei;WANG Shu-hui(Qilu Hospital of Shandong University,Jinan,Shandong 250012,China;不详)

机构地区：[1]山东大学齐鲁医院感染管理处,山东济南250012 [2]山东大学护理学院,山东济南250012

出　　处：《中华医院感染学杂志》2020年第6期888-892,共5页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(ZR2018MG015)。

摘　　要：目的分析脑卒中手术患者医院感染所造成的经济负担,为医院管理者制定相关政策提供依据。方法回顾性收集2016年1月-2018年12月山东大学齐鲁医院脑卒中手术患者的临床相关资料,根据是否发生医院感染,将患者分为感染组和非感染组,以年龄±10岁、性别、手术方式、手术级别、手术次数作为匹配依据变量进行1∶1匹配,估算脑卒中手术患者由于医院感染导致的超额医疗费用,在此基础上,采用边际分析法探讨医院感染导致的医院经济损失。结果共纳入816例脑卒中手术患者,发生医院感染216例,感染发生率为26.10%。医院感染患者的总超额医疗费用比例约为26.58%。2016年脑卒中手术患者由于医院感染导致医院的经济损失约为13.85万元[边际利润率(M%)=5%]、27.66万元(M%=10%)、41.51万元(M%=15%);2017年约为16.12万元(M%=5%)、32.22万元(M%=10%)、48.34万元(M%=15%);2018年约为12.58万元(M%=5%)、25.14元(M%=10%)、37.72万元(M%=15%)。患者医院感染损失利润比与感染率系数约为0.34。结论脑卒中手术患者若发生医院感染,可以使患者产生巨大的超额医疗费用,同时降低医院的经济收益,增加患者与医院的经济负担,因此临床医务人员应采取相应预防与控制措施,以降低医院感染发生率。OBJECTIVE To investigate the economic burden of the stroke surgery patients due to nosocomial infection so as to provide guidance for development of relevant policies. METHODS The related clinical data were retrospectively collected from the stroke patients who received surgery in Qilu Hospital of Shandong University from Jan 2016 to Dec 2018, the enrolled patients were divided into the infection group and the non-infection group according to the status of nosocomial infection. The age±10 years old, gender, surgery mode, surgery grade and number of times of surgery were used as variables and performed for 1∶1 matching,the excess medical cost of the stroke patients due to the nosocomial infection was estimated, and the economic loss of the hospital due to nosocomial infection was observed by means of marginal analysis. RESULTS Of totally 816 stroke patients, 216 had nosocomial infection, with the infection rate 26.10%. The proportion of total excess medical cost of the patients with nosocomial infection was about 26.58%. The economic loss of the hospital due to the nosocomial infection in the stroke patients was about 138,500 RMB(M%=5%), 276,600 RMB(M%=10%), and 415,100 RMB(M%=15%) in 2016, 161,200 RMB(M%=5%), 322,200 RMB(M%=10%), and 483,400 RMB(M%=15%) in 2017, 125,800 RMB(M%=5%), 25.14 RMB(M%=10%), 377,200 RMB(M%=15%) in 2018. The coefficient of the profit ratio of loss due to nosocomial infection and the infection rate was about 0.34. CONCLUSION The nosocomial infection in the stroke patients can result in huge amount of excess medical cost, reduce the economic profit of the hospital and increase the economic burden of the hospital, therefore, it is necessary for the clinical health care workers to take targeted prevention measures so as to reduce the incidence of nosocomial infection.

关 键 词：脑卒中 医院感染 经济负担 边际分析法 

分 类 号：R743[医药卫生—神经病学与精神病学]