北京协和医院老年病房终末期患者的住院费用及构成  

Inpatient Care Expenditure of Terminally Ill Patients in the Geriatric Ward of Peking Union Medical College Hospital

作　　者：金爽 刘硕 汪雪萍 布鲁汗·哈兰 陈冬妮 袁欣瑞 葛楠 宁晓红 JIN Shuang;LIU Shuo;WANG Xueping;Buluhan·Halan;CHEN Dongni;YUAN Xinrui;GE Nan;NING Xiaohong(Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Geriatrics,Qinghai University Affiliated Hospital,Xining 810001,China;Department of Geriatrics,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumuqi 830000,China;Department of Geriatrics,the First Affiliated Hospital of Shenzhen University,Shenzhen,Guangdong 518000,China;Department of Geriatrics,Inner Mongolia People’s Hospital,Hohhot 010017,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院老年医学科,北京100730 [2]青海大学附属医院老年医学科二病区,西宁810001 [3]新疆自治区人民医院干部保健二科,乌鲁木齐830000 [4]深圳大学第一附属医院老年医学科,广东深圳518000 [5]内蒙古自治区人民医院干部保健所,呼和浩特市010017

出　　处：《中国医学科学院学报》2021年第1期15-20,共6页Acta Academiae Medicinae Sinicae

基　　金：中国医学科学院北京协和医学院教学改革项目(2019zlgc0119)。

摘　　要：目的了解北京协和医院老年病房中末期患者的住院费用及构成情况,为进一步研究安宁缓和医疗的卫生经济学价值提供依据。方法浏览北京协和医院老年医学病房2018年内入院的患者病史,根据统一标准,选取适合进入安宁疗护的终末期患者,收集并归纳重要人口学信息及病情情况,对住院费用及其组成进行计算。结果共有35例患者入选,其中,男20例,女15例,平均年龄(78±8)岁(59~91岁),平均年龄校正查尔森合并症指数10±3,中位日常生活活动能力评分40(10,70)分;晚期恶性肿瘤23例,慢性心力衰竭4例,终末期慢性肾脏疾病1例,终末期肝病2例,痴呆4例,其他严重疾患3例。患者在院期间接受规范内科、老年医学科治疗,最终死亡8例,出院27例。35例患者的中位住院天数为15(12,23)d,中位住院费用为2.15(1.38,3.76)万元,中位日均费用1425(970,2503)元;平均药费占比(28.5±12.3)%,检查检验费占比(33.2±18.0)%,中位床位费占比11.5%(6.4%,15.8%);日均控制症状药物费用(77±58)元,平均占总住院费比例为(5.2±3.5)%。结论与基层医院的安宁疗护病房相比,终末期患者入住三级医院老年病房的费用较高。费用组成方面,药费与检查费占比接近,症状控制费用较低。我国需进一步研究安宁缓和医疗对终末期患者医疗费用的影响。Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21500(13800,37600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)%for medication,(33.2±18.0)%for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)%of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom contr

关 键 词：安宁缓和医疗 费用 价值导向的医疗 症状控制 终末期疾病患者 住院 

分 类 号：R48[医药卫生—临床医学] R592[医药卫生—老年医学]