基于真实世界数据的住院患者跌倒成本效益研究  

Research on cost-benefit analysis of in-hospital falls: based on real world data

作　　者：夏丽霞 林征[1] 顾则娟[1] 陈鹏 王荣[1] Xia Lixia;Lin Zheng;Gu Zejuan;Chen Peng;Wang Rong(Department of Nursing,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Geriatric Neurology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院护理部,南京210029 [2]南京医科大学第一附属医院老年神经内科,南京210029

出　　处：《中国实用护理杂志》2022年第22期1728-1734,共7页Chinese Journal of Practical Nursing

基　　金：中华护理学会团体标准项目(T/CNAS02-2019)。

摘　　要：目的:基于医院电子病历真实世界的临床数据,探析住院跌倒、跌倒伤害住院时间及成本费用现状。方法:本研究为回顾性队列研究。基于南京医科大学第一附属医院电子病历系统,选取2017年1月至2019年12月医院护理管理信息系统跌倒上报科室的住院患者为研究对象,共纳入74个科室38481例研究对象。对患者特征、跌倒、跌倒伤害、住院时间、自下而上直接成本数据情况进行分析。结果:2017年1月至2019年12月发生跌倒243例占0.6%,跌倒伤害154例占63.4%;跌倒患者住院时间中位数为19 d,高于未跌倒患者的7 d,差异有统计学意义(Z=-15.18,P<0.05)。跌倒患者住院费用中位数为39000元,高于未跌倒患者的16300元,差异有统计学意义(Z=-11.47,P<0.01)。受伤与未受伤患者之间,住院时间及住院费用差异均无统计学意(Z=-0.92、-0.64,P>0.05)。线性回归模型分析显示,性别、年龄、共病、住院科室单元、住院原因与跌倒住院费用、住院时间有影响(F=280.05、217.31,均P<0.05)。结论:住院跌倒患者医疗资源使用及直接成本增加,可能主要归因于跌倒本身而非跌倒伤害。本研究可为真实世界优化策略研究、合理资源分配及跌倒预防成本效益评价提供参考。Objective Based on the real-world clinical data of hospital electronic medical records,to analyze the length of stay and healthcare costs associated with in-hospital falls and fall injuries in hospitals.Methods Based on the electronic medical record system of the First Affiliated Hospital of Nanjing Medical University,a retrospective cohort study was conducted on patients admitted to these departments reported falls in nursing management information system from January 2017 to December 2019.A total of 38481 patients from 74 units were enrolled in this study.The patients′characteristics,falls,falls injury,and explore the length of hospital stay and bottom-up direct cost were analyzed.Results A total of 243 cases(0.6%)fell and 154 cases(63.4%)were injured by falls from January 2017 to December 2019.Compared with non-fallers,the median length of stay of patients with falls was 19 days,which was significantly increased compared with 7 days of patients without falls(Z=-15.18,P<0.05).The median hospitalization cost of patients with falls was 39000 yuan,which was significantly higher than 16300 yuan of patients without falls(Z=-11.47,P<0.01).There was no statistical difference between non-injuried fallers and injuried fallers for length of stay and healthcare costs(Z=-0.92,-0.64,P>0.05).Linear regression model analysis showed that gender,age,comorbidity,inpatient department unit,reason of hospitalization were significantly correlated with inpatient cost and length of stay(F=280.05,217.31,all P<0.05).Conclusions Patients who have an in-hospital fall have significantly longer hospital stays and higher direct costs,mainly can be attributed to the fall itself,not the injury.Our findings have important financial implications for real world in light of optimal intervention strategies,resource allocation and economic evaluation of fall prevention.

关 键 词：医院 住院时间 跌倒 费用 电子病历 真实世界数据 

分 类 号：R197.3[医药卫生—卫生事业管理]