农村居民创伤患者住院费用构成及影响因素研究  

Study on the Composition and Influencing Factors of Hospitalization Expenses for Rural Residents with Trauma

作　　者：王瑞宇 张钰璐 何俊曦 吴振宇 何作顺 谷仕艳 王靖 Wang Ruiyu;Zhang Yulu;He Junxi;Wu Zhenyu;He Zuoshun;Gu Shiyan;Wang Jing(School of Clinical Medicine&Public Health,Dali University,Dali Bai Autonomous Prefecture 671013,Yunnan Province,China;不详)

机构地区：[1]大理大学临床医学院,云南省大理白族自治州671013 [2]大理大学公共卫生学院,云南省大理白族自治州671013

出　　处：《中国病案》2024年第3期92-95,112,共5页Chinese Medical Record

基　　金：2020年大理市科技项目(2020kGB063)。

摘　　要：目的挖掘与分析农村居民创伤患者住院费用的内部构成及影响因素,为制定减轻农村居民创伤患者疾病经济负担的管理决策提供理论依据。方法提取云南省某三甲医院2018年1月1日-2021年12月31日农村居民创伤住院患者的住院病案首页信息9493份,采用灰色关联分析、单因素分析、多重线性回归分析和随机森林回归树模型研究农村居民创伤患者住院费用构成及影响因素。结果2018-2021年农村居民创伤患者住院费用总体呈下降趋势,年均增长率为-2.82%。住院费用内部因素关联度分析结果显示分类费用中的耗材费和药费与住院费用关联度最高,关联度分别为1.00和0.84。单因素分析筛选出年龄、住院天数、入院途径及损伤部位等8种外部因素对住院费用产生显著影响,P<0.001。多重线性回归模型分析结果显示除性别、综合医疗服务费、诊断费、治疗费、血液和血液制品费和其他费用以外的10种因素均显著影响住院费用。采用随机森林回归树模型对这些内外部因素进行重要程度排名,耗材占比、住院天数、是否三级与四级手术、药占比以及是否使用呼吸机排名前5。结论应合理增加服务类费用比例,确保在提升医疗服务质量的基础上推进耗材与药品改革全面升级,进而优化农村居民住院费用内部结构。推进分级诊疗制度、规范临床路径,合理缩短住院时间,以切实减轻患者疾病经济负担。Objectives This study aims to explore and analyze the internal composition and influencing factors of hospitalization expenses of trauma patients in rural areas,so as to provide a theoretical basis for making management decisions to reduce the economic burden of disease in rural residents with trauma.Methods 9,493 pieces of medical record front page information of rural trauma patients in a top-three hospital in Yunnan Province from January 1,2018 to December 31,2021were extracted.Grey correlation analysis,single factor analysis,multiple linear regression analysis,and random forest regression tree model were used to study the composition and influencing factors of hospitalization costs of rural trauma patients.Results From January 1,2018 to December 31,2021,the hospital's hospital expenses for trauma patients in rural residents showed a decreasing trend,with an average annual growth rate of-2.82%.The results of the correlation analysis of internal factors of hospitalization expenses showed that the consumables cost and drug cost had the highest correlation with hospitalization expenses,and the correlation degrees were 1.00 and 0.84,respectively.Single-factor analysis screened out 8 external factors such as age,length of hospitalization,route of admission,and location of injury that have a significant impact on hospitalization costs(P<0.001).The results of multiple linear regression model analysis showed that 10 factors,except gender,comprehensive medical service fee,diagnosis fee,treatment fee,blood and blood products fee,and other costs,significantly affected the hospitalization cost.Furthermore,the random forest regression tree model was used to rank the importance of these internal and external factors.The results showed that the proportion of consumables,the length of hospital stay,whether the third or fourth-grade surgery,the proportion of drugs,and whether the ventilators were used ranked among the top five influencing factors.Conclusions The health and prevention education of trauma diseases in rural resid

关 键 词：住院费用 影响因素 创伤 农村居民 

分 类 号：R197.323[医药卫生—卫生事业管理] R641[医药卫生—公共卫生与预防医学]