漯河市某医院出血性脑卒中住院病例特征及费用影响因素分析  

Analysis of the Characteristics and Cost Influencing Factors of Hospitalized Patients with Hemorrhagic Stroke at a Hospital in Luohe

作　　者：王艳华[1] 段文锴[2] 代彦丽[3] WANG Yanhua;DUAN Wenkai;DAI Yanli(Medical Records Room,Luohe Central Hospital,Luohe Henan 462000,China;Department of Oral and Maxillofacial Surgery,Luohe Central Hospital,Luohe Henan 462000,China;Medical Records Room,The First Affiliated Hospital of Henan University,Kaifeng Henan 475001,China)

机构地区：[1]漯河市中心医院病案室,河南漯河462000 [2]漯河市中心医院口腔颌面外科,河南漯河462000 [3]河南大学第一附属医院病案室,河南开封475001

出　　处：《临床研究》2025年第5期188-193,共6页Clinical Research

摘　　要：目的研究出血性脑卒中患者的住院费用构成及其影响因素,以期为住院医疗资源的合理配置提供决策依据。方法回顾性分析2019年1月1日至2023年12月31日漯河市某三甲医院的病案首页信息,采用描述性统计、卡方检验、非参数Mann-Whitney U检验、非参数Kruskal-Wallis检验和多重线性逐步回归方法分析出血性脑卒中住院病人总费用的影响因素。结果在出血性脑卒中住院患者的各项费用中,药品费、治疗费、综合医疗服务费位于前3位。其构成比分别为40.36%、19.50%、15.74%,构成比最低的是诊断费(10.66%)。人均费用最高的是2021年,不同年份住院费用间存在差异(H=28.313,P<0.001)。2019年至2023年出血性脑卒中住院患者季节分布特点,春季(3至5月)及冬季(1至2月,12月)住院患者高于夏季(6至8月)及秋季(9至11月)住院患者。不同年份季节间出血性脑卒中住院病人数差异具有统计学意义(χ^(2)=26.973,P<0.05)。不同年龄、医疗付款方式入院情况、是否急诊入院、住院天数、是否手术、出院情况、入院时病情严重程度均对住院费用有显著影响,差异有统计学意义(P<0.05),其中手术、住院时间及病情严重程度是主要驱动因素。年轻患者、急诊入院、首次住院、住院时间长、接受手术及病情危重的患者住院费用较高。多元回归分析中影响住院费用的各因素按影响力从大到小排序为是住院天数、是否手术、入院时病情严重程度和医疗付款方式,差异有统计学意义(P<0.05)。住院天数是影响住院费用的最主要因素,其次是手术费用。结论出血性脑卒中患者具有明显的季节分布特征,患者的住院负担较大,缩短住院时间有助于减轻负担,降低药品费用,合理配置医疗资源,优化管理流程,加强出血性脑卒中预防的健康宣教,早发现早治疗,可以合理控制患者的住院费用。Objective To study the composition of hospitalization costs and influencing factors in patients with hemorrhagic stroke,aiming to provide decision-making references for the rational allocation of inpatient medical resources.Methods A retrospective analysis of the medical record information from January 1,2019,to December 31,2023,was conducted for patients with hemorrhagic stroke admitted to a tertiary hospital in Luohe.Descriptive statistics,chi-square tests,non-parametric Mann-Whitney U tests,non-parametric Kruskal-Wallis tests,and multiple linear stepwise regression analysis were employed to analyze the factors influencing the total hospitalization costs.Results Among the various costs incurred by hospitalized patients with hemorrhagic stroke,medication costs,treatment fees,and comprehensive medical service fees were the top three,with composition ratios of 40.36%,19.50%,and 15.74%,respectively,while the lowest composition ratio was for diagnostic fees(12.10%).The average cost per patient was highest in 2021,and significant differences in hospitalization costs were observed across different years(H=28.313,P<0.001).From 2019 to 2023,the seasonal distribution showed that hospitalization rates in spring(March to May)and winter(January to February,December)were higher than those in summer(June to August)and autumn(September to November).The differences in the number of hospitalized hemorrhagic stroke patients between seasons in different years were statistically significant(χ^(2)=26.973,P<0.05).Significant factors influencing hospitalization costs included age,method of medical payment,emergency admission status,length of stay,surgical treatment,discharge status,and severity of condition at admission(P<0.05).Specifically,surgery,length of stay,and severity of condition were identified as the main driving factors for costs.Younger patients,emergency admissions,first-time admissions,longer lengths of stay,surgical treatment,and patients with severe conditions incurred higher hospitalization costs.In the multiple reg

关 键 词：出血性脑卒中 特征 住院费用 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]