ICU脓毒症护理成本构成影响因素及RBRVS、TDABC在成本核算中的应用研究  

Analysis of nursing cost composition and application of RBRVS and TDABC in ICU sepsis

作　　者：马英芝 李玲[2] 刘海凤 侯铭[4] 肖江琴[4] 郭峻氚[2] 李洁[2] MA Yingzhi;LI Ling;LIU Haifeng;HOU Ming;XIAO Jiangqin;GUO Junchuan;LI Jie(College of Nursing,Xinjiang Medical University,Urumqi,Xinjiang 830001,China;不详)

机构地区：[1]新疆医科大学护理学院,新疆乌鲁木齐830001 [2]新疆维吾尔自治区人民医院重症医学科,新疆乌鲁木齐830000 [3]新疆维吾尔自治区人民医院放疗科 [4]新疆维吾尔自治区人民医院护理部

出　　处：《中华全科医学》2025年第5期881-885,共5页Chinese Journal of General Practice

基　　金：新疆维吾尔自治区自然科学基金资助项目(2021D01C156);新疆维吾尔自治区人民医院院内项目(20220245)。

摘　　要：目的 随着医疗技术的进步,脓毒症相关的护理需求也在不断增加,同时护理成本也在不断攀升。为有效降低护理的总开支,提高医疗服务效率和质量,本研究旨在探究ICU脓毒症护理成本构成影响因素及成本相对值法(RBRVS)和时间驱动作业成本法(TDABC)在成本核算中的应用效果。方法 调取2023年1—6月新疆维吾尔自治区人民医院病案室218例脓毒症患者的临床资料。根据相关资料明确护理服务项目内容、记录操作频次,使用RBRVS和TDABC对脓毒症相关的护理成本进行核算。计算脓毒症护理服务项目总成本构成比,对比总成本与实际收费差异,计算回收比例。使用多元线性回归分析影响护理成本的主要因素。结果 护理成本构成中人力成本占73.10%,材料成本占13.29%,间接成本占13.61%。结果得出脓毒症单病种护理服务项目平均总成本为72 861.174元,实际收费为21 181元,回收比例为29.07%。不同年龄、ICU入住时间、机械通气方式、是否合并压力性损伤患者的护理成本差异有统计学意义(P<0.05)。多元线性回归分析显示,年龄、ICU入住时间、机械通气方式、合并压力性损伤、护理人员成本意识均是护理成本的影响因素(P<0.05)。结论 脓毒症护理服务项目成本受患者年龄、ICU入住时间、机械通气方式、合并压力性损伤、护理人员成本意识等因素影响。使用RBRVS和TDABC法能有效简化相关成本的核算,并反映出实际收费远远低于核算结果。定价机构需参照成本核算来设定合理的收费标准,加强人力、材料成本分配及间接成本的管控。Objective With advancements in medical technology,the demands for sepsis-related nursing and nursing cost are increasing.In order to effectively reduce the total cost of nursing and improve the efficiency and quality of medical services,it is necessary to explore factors influencing nursing cost composition and to evaluate the application of the resource-based relative value scale(RBRVS)and time-driven activity-based costing(TDABC)models in the care of ICU patients with sepsis.Methods The clinical data from 218 patients with sepsis admitted to the People's Hospital of Xinjiang Uygur Autonomous Region between January and June 2023 were retrospectively analyzed.According to relevant data,content of nursing services and operating frequency were recorded.The costs of sepsis-related nursing were calculated by RBRVS and TDABC.The composition ratios of total nursing costs were calculated,and the differences between total costs and actual charges were analyzed to assess the cost recovery rate.The main factors influencing nursing costs were analyzed by multiple linear regression analysis.Results In terms of different nursing cots,proportions of labor,material,and indirect costs were 73.10%,13.29%,and 13.61%,respectively.The average total cost of sepsis-related nursing services was 72861.174 yuan,while the actual charge was 21181 yuan,resulting in a cost recovery rate of 29.07%.Significant differences in nursing costs were observed across groups based on age,ICU stay duration,mechanical ventilation modes,and presence of pressure injuries(P<0.05).Multiple linear regression analysis identified age,ICU stay duration,mechanical ventilation mode,pressure injuries,and cost-awareness among nursing staff as factors influencing nursing cost(P<0.05).Conclusion The factors influencing the cost of sepsis nursing services include patients age,ICU stay duration,mechanical ventilation modes,presence of pressure injuries,and cost-awareness among nursing staffs.RBRVS and TDABC can effectively facilitate the accounting of related costs,refl

关 键 词：脓毒症 护理服务 成本核算 成本管理 

分 类 号：R631[医药卫生—外科学] R47[医药卫生—临床医学]