基于倾向值匹配的日间手术控费效果分析  

Effect analysis of day surgery cost control based on propensity value matching

作　　者：周苑 周典[1] 田帝 方秀斌[1] 吴烨 王怡凡 姚辰欢 汪恒 杨琰 接纯纯 Zhou Yuan;Zhou Dian;Tian Di;Fang Xiubin;Wu Ye;Wang Yifan;Yao Chenhuan;Wang Heng;Yang Yan;Jie Chunchun(Medical Administration Division,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Medical Administration Division,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Health Management,School of Health Management,Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第二附属医院医务部,合肥230601 [2]安徽医科大学第一附属医院医务处,合肥230022 [3]安徽医科大学卫生管理学院卫生管理系,合肥230032

出　　处：《中华医院管理杂志》2022年第2期110-114,共5页Chinese Journal of Hospital Administration

基　　金：安徽省卫生健康委科研项目(AHWJ2021a022);合肥市哲学社会科学规划项目(HFSKQN202145);合肥市医疗卫生借转补研发项目(J2020Y04);安徽医科大学校科研基金(2021XKJ294)。

摘　　要：目的分析日间手术住院费用构成和结构变化及其影响因素,为优化日间手术控费提供参考。方法收集2020年某市3家三级甲等综合医院日间手术量排名前3位病种(下肢静脉曲张、慢性胆囊炎和精索静脉曲张)的患者病案首页数据,通过倾向性匹配消除混杂因素,采用结构变动度分析住院费用结构变化,采用灰色关联度和多重线性回归分析住院费用影响因素。结果对752例日间手术和非日间手术患者的病案首页数据进行1∶1倾向性匹配后,最终纳入492例患者数据,其中下肢静脉曲张患者98例,慢性胆囊炎患者356例,精索静脉曲张患者38例。与非日间手术组相比,日间手术组的住院费用下降,慢性胆囊炎、精索静脉曲张和下肢静脉曲张3个病种的费用结构变动度分别为14.59%、6.20%和16.20%,其中一般医疗服务费、护理费和检查化验费呈下降趋势,材料费、药品费呈上升趋势。一般医疗服务费、护理费、检查化验费、临床诊断费、治疗费、药品费、材料费与日间手术住院总费用关联度大(灰色关联度>0.90)。支付方式、切口愈合类型、出院诊断对日间手术住院总费用有影响(P<0.05)。结论与非日间手术相比,日间手术住院费用总体降低,但并非所有项目费用均降低,影响日间手术住院费用的主要因素为费用内部构成、支付方式等。医院应重点挖掘日间手术内在控费潜力,进一步扩大日间手术病种覆盖范围。Objective To analyze the composition,the changes of expense structure and the influencing factors of hospitalization expenses,for reference in optimizing the cost control of day surgery.Methods Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs,chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020.The confounding factors were eliminated through propensity matching.The structural change of hospitalization expenses was analyzed by structural change degree,and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery,98 patients with lower extremity varicose veins,356 patients with chronic cholecystitis and 38 patients with varicocele were finally included.Compared with non day hand,the total hospitalization cost of day surgical instruments decreased,and the cost structure changes of chronic cholecystitis,varicocele and varicose veins of lower limbs were 14.59%,6.20%and 16.20%respectively.Among them,the general medical service fee,nursing fee and examination and laboratory fee showed a downward trend,and the fees of materials and drugs showed an upward trend.General medical service fee,nursing fee,examination and laboratory fee,clinical diagnosis fee,treatment fee,drug fee,material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90).The payment method,wound healing type and discharge diagnosis can influence the cost of day surgery(P<0.05).Conclusions Compared with non daytime surgery,the total hospitalization cost of day surgery has a certain cost control effect,but it can not reduce the cost of all projects.The main influencing factors are the internal composition of the cost,payment method and so on.The hospitals should focus on tapping the internal cost control

关 键 词：费用控制 日间手术 住院费用 倾向值匹配法 结构变动度 灰色关联度 

分 类 号：R197.3[医药卫生—卫生事业管理]