卒中转诊网络特征与医疗费用及住院天数关系研究——基于广州医疗保险数据的回顾性分析  

Study on Relationship between Characteristics of Stroke Referral Network and Medical Costs and Length of Stay:an Retrospective Analysis based on Medical Insurance Data in Guangzhou

作　　者：冯智朗 张慧[1] Feng Zhilang;Zhang Hui(School of Public Health,Sun Yat-sen University,Guangzhou,Guangdong,510080,China;不详)

机构地区：[1]中山大学公共卫生学院,广东广州510080

出　　处：《中国医院管理》2024年第7期31-35,共5页Chinese Hospital Management

基　　金：国家自然科学基金项目(72274225);广东省基础与应用基础研究基金(2023A1515011725)。

摘　　要：目的探讨医院在卒中转诊网络中的特征与医疗费用及住院天数的关系,为推进卒中分级诊疗提供政策建议。方法采用社会网络分析方法探索医疗机构在卒中转诊网络中的特征,采用多重线性回归分析网络结构指标对患者次均住院天数、次均住院总费用及个人自付费用的影响。结果在初始网络中共纳入卒中住院患者11918人,医院158家。随着网络阈值的上升,患者次均住院天数从15.76天下降至15.60天,次均住院总费用从12570.57元下降至11897.40元,次均个人自付费用从1745.66元下降至1558.91元。在阈值=16的网络中,患者共转诊89740次,其中三级医院的转出和转入人次均最多,分别为23485次和21371次。除在最紧密的网络中各级医院的度中心度无差异外,三级医院在转诊网络中各项中心度指标均最高。较高的度中心度与较低的住院总费用及个人自付费用有关联,较高的紧密中心度与较短的住院天数有关联。结论三级医院在卒中转诊网络中占据主要地位,二级医院没有充分体现在卒中分级诊疗体系中的中介作用。应提高转诊网络的紧密程度,形成医疗机构间更高质量、紧密快捷的合作关系,降低患者的医疗费用和住院天数。Objective Explore the relationship between hospital characteristics and medical costs and length of stay,and thus provide policy recommendations for promoting the system of stroke classification and treatment.Methods Social Network Analysis methods were employed to explore the characteristics of medical institutions in stroke referral network,with multiple linear regression analysis used to explore the impact of network structure metrics on patients'length of stay,total hospitalization costs,and out-of-pocket expenses.Results A total of 11918 stroke inpatients and 158 hospitals were included in the initial network.As the network threshold increases,the average length of stay per admission decreased from 15.76 days to 15.60 days,the average total hospitalization cost per admission decreased from 12570.57 yuan to 11897.40 yuan;and the average out-of-pocket cost per admission decreased from 1745.66 yuan to 1558.91 yuan.In the network with a threshold of 16,patients were referred a total of 89740 times,with tertiary hospitals having the highest number of referrals(23485 times for referral out and 21371 times for referral in).Tertiary hospitals had the highest proportion of hospitals and centrality metrics in the referral network,except for degree centrality in the densest network.Higher centrality was associated with lower total hospitalization costs and out-of-pocket expenses,while higher closeness centrality was associated with shorter length of stay.Conclusion Tertiary hospitals occupied a dominant position in the stroke referral network.Secondary hospitals did not play an intermediary role in the system of stroke classification and treatment.Increasing the closeness of the referral network and forming closer and faster cooperation between medical institutions is beneficial to lower medical costs and length of stay.

关 键 词：卒中 转诊 医疗费用 住院天数 社会网络分析 

分 类 号：R197.322[医药卫生—卫生事业管理]