基于倾向指数匹配法的某三甲医院白内障日间手术住院费用分析  

Analysis of hospitalization cost of cataract day surgery in a tertiary grade A hospital based on propensity score matching

作　　者：来庆玲 梁沛枫[2] 冯园园 丁凡 李银山 LAI Qingling;LIANG Peifeng;FENG Yuanyuan;DING Fan;LI Yinshan(College of Humanities and Management,Ningxia Medical University,Yinchuan Ningxia 750004,China;People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan Ningxia 750001,China;Guyuan People’s Hospital,Guyuan Ningxia 756000,China)

机构地区：[1]宁夏医科大学人文与管理学院,宁夏银川750004 [2]宁夏回族自治区人民医院,宁夏银川750001 [3]固原市人民医院,宁夏固原756000

出　　处：《卫生软科学》2024年第7期66-70,共5页Soft Science of Health

基　　金：2022年宁夏哲学社会科学年度规划项目(22NXBGL15)。

摘　　要：[目的]分析日间手术患者住院费用构成、结构变化及其影响因素。[方法]纳入2019年1月1日-2021年12月31日在宁夏某三级甲等医院实施白内障手术的患者,首先通过倾向指数匹配法均衡日间手术组和非日间手术组两组间混杂因素,利用秩和检验对匹配后的数据进行比较;采用结构变动度、灰色关联分析和多元线性回归等方法对日间手术患者住院费用结构变化情况以及影响因素进行分析。[结果]经倾向指数匹配后,2组各得到1483例患者,协变量在组间分布达到均衡;与非日间手术组相比,日间手术组患者住院费用下降,耗材费用占比相对较高;2019-2021年,住院费用结构变动度为31.40%,治疗费和耗材费用累计结构变动贡献率为94.14%,其中治疗费结构变动贡献率最大为49.41%。综合医疗服务费、诊断费呈现正向变动,诊断费、药品费、耗材费、其他费用呈现负向变动。2019-2021年,耗材费与日间手术住院费用的关联度最大,性别、年龄是影响日间手术患者住院费用的因素(P<0.05)。[结论]与非日间组相比,日间组患者住院总费用降低,体现医务人员劳动价值的费用结构需继续优化。影响日间手术患者住院费用的主要因素有耗材费、年龄、性别等,应该继续探索日间手术的内在控费潜力,做好外部控费保障。Objective To analyze the composition,structural changes and influencing factors of patients hospitalization cost of ambulatory surgery.Methods Patients who underwent cataract surgery in a tertiary grade A hospital in Ningxia from January 1st,2019 to December 31st,2021 were included.Firstly,confounders between day surgery group and the inpatient surgery group were equalized by propensity score matching method,and the matched data were compared by rank sum test.The structural variation,grey correlation analysis,and multivariate linear regression were used to analyze the structural change and influencing factors of patients hospitalization cost of ambulatory surgery.Results 1483 patients were obtained in each group through propensity index matching,and the distribution of covariates reached equilibrium between the groups.Compared with the general surgery group,the hospitalization cost of the day surgery group decreased,and the proportion of consumables cost was relatively high.From 2019 to 2021,the degree of structural variation of hospitalization cost was 31.40%,and the cumulative contribution rate of treatment cost and consumables cost was 94.14%,among which the largest contribution rate of treatment cost was 49.41%.Comprehensive medical services fees and diagnostic fees showed positive changes,and the expenses of diagnosis,medicine,consumables and other expenses showed a negative change.From 2019 to 2021,the cost of consumables had the largest correlation with the hospitalization cost of day surgery;gender and age were the factors affecting patients hospitalization cost of ambulatory surgery(P<0.05).Conclusions Compared with the general surgery group,the total hospitalization cost of patients in the ambulatory surgery group is reduced,and the cost structure reflecting the value of medical staff’s efforts should be further optimized.The main factors affecting the hospitalization cost of ambulatory surgery are consumables fees,age,gender and so on.We should continue to explore the internal potential for cost cont

关 键 词：日间手术 倾向指数匹配法 结构变动度 灰色关联分析 费用控制 

分 类 号：R197.3[医药卫生—卫生事业管理]