泰兴市某医院12256例恶性肿瘤患者住院费用结构及影响因素  

The Hospitalization Cost Structure and Influencing Factors of 12256 Malignant Tumor Patients in Taixing

作　　者：李慧[1] 宇传华[2] 李占结 李晓丽 丁芬 徐康[1] Li Hui;Yu Chuanhua;Li Zhanjie;Li Xiaoli;Ding Fen;Xu Kang(Department of Medical Affairs,Taixing People's Hospital,Taixing 225400,Jiangsu Province,China;不详)

机构地区：[1]泰兴市人民医院医务处,江苏省泰兴市225400 [2]武汉大学公共卫生学院流行病与统计学系,湖北省武汉市430071 [3]南京医科大学第一附属医院感染管理处,江苏省南京市210029 [4]泰兴市人民医院质控科,江苏省泰兴市225400

出　　处：《中国病案》2024年第4期58-61,共4页Chinese Medical Record

基　　金：江苏省医院医院协会2023年医院管理创新研究课题(JSYGY-3-2023-559);2022年度湖北省卫生总费用核算研究(含功能法)。

摘　　要：目的分析恶性肿瘤患者住院费用结构变化及主要影响因素,为合理控制住院费用提供数据支持。方法收集2018年1月1日-2023年6月30日江苏省泰州市某三级医院主诊断为C00-C97的12256例出院患者住院病案首页信息,采用四分位数间距、非参数检验对住院费用进行分析描述,多元线性回归分析病例数量在前3位的恶性肿瘤住院费用影响因素。结果消化系统(5976例,48.76%)、呼吸系统(1968例,16.06%)以及泌尿生殖系统(1780例,14.52%)病例数量占比前三,次均费用分别为26326.0元、14495.5元、16200.3元;各类恶性肿瘤住院费用主要集中在药品、耗材及诊断费;线性回归显示,性别、年龄、转科、住院天数、危重、手术、付费方式等均为总费用的抑制或促进因素,模型R2均在66%以上,模型拟合良好,P<0.05;其中住院天数及手术分级对费用影响最大,标准化系数均在0.378-0.565之间。结论该院恶性肿瘤患者疾病负担仍然较重,住院天数、手术分级、肿瘤种类是影响恶性肿瘤患者次均直接医疗费用的主要因素;降低住院日,控制药占比,扩大DRG付费试点,开展多学科联合诊疗是关键,医疗机构及疾控部门做好本地重点病种的三级预防是根本。Objective To analyze the changes in the hospitalization cost structure of malignant tumor patients and the main influencing factors,in order to provide data support for reasonable control of hospitalization costs.Method The front pages information of 12256 discharged patients with primary diagnosis of C00-C97 from a tertiary hospital in Taizhou City,Jiangsu Province from January 1st,2018 to June 30th,2023 was collected.The hospitalization expenses were analyzed and described using interquartile spacing and non-parametric tests.Multiple linear regression analysis was used to identify the factors influencing hospital expenses for malignant tumors in the top three cases.Results The digestive system(5976 cases,48.76%),respiratory system(1968 cases,16.06%)and genitourinary system(1780 cases,14.52%)accounted for the top three cases,and the average cost was 26326.0 yuan,14,495.5 yuan and 16,200.3 yuan,respectively.The hospitalization expenses of all kinds of malignant tumors mainly focus on drugs,consumables and diagnosis fees.Linear regression showed that gender,age,transfer department,hospitalization days,critical severity,surgery,payment method,etc.were all inhibiting or promoting factors of total cost,and the model R2 was above 66%,indicating good model fitting(P<0.05).The number of days in hospital and the grade of surgery had the greatest impact on the cost,and the standardized coefficients were between 0.378-0.565.Conclusions The disease burden of malignant tumor patients in this hospital was still heavy,and the number of days in hospital,the grade of operation and the type of tumor were the main factors affecting the direct medical expenses of malignant tumor patients per time.The key was to reduce the length of stay,control the proportion of drugs,expand the DRG payment pilot,and carry out multidisciplinary joint diagnosis and treatment.It was fundamental for medical institutions and disease control departments to do a good job in the tertiary prevention of local key diseases.

关 键 词：恶性肿瘤 住院费用 线性回归 

分 类 号：R730[医药卫生—肿瘤] R197.3[医药卫生—临床医学]