住院病案首页中住院费用影响因素分析
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摘要
目的探讨住院病案首页中住院费用影响因素分析。方法选取2015年7月-2017年9月某市12所三级医院诊治的87942例住院患者作为研究对象,采用多元逐步回归模型分析住院患者疾病谱构成情况,医院各项住院费用的构成情况,住院患者社会特征与人均住院费用关系,住院患者疾病严重度与人均住院费用的关系,医院诊疗质量与人均住院费用情况分析。结果住院患者损伤和中毒构成比最高,占16. 94%,其次为呼吸系统疾病构成比为13.81%、消化系统疾病构成比11. 81%。12所医院药费占住院费用比重最大,为37.85%,其次为治疗费用;人均住院费用随着年龄的增长明显升高;统计比较各项差异均具有统计学意义。人院方式、人院情况、抢救次数、特护天数、一级护理、并发症、院内感染、手术、住院天数与人均住院费用均有明显差异,且随着住院天数、一级护理天数和特护天数增加人均住院费用逐渐增加,差异具有统计学意义。结论住院病案首页中住院费用影响因素因素包括住院天数,人院方式,人院情况及治疗结果、特护天数、住院天数、一级护理、抢救次数、年龄;其中特护天数是影响住院费用的主要因素。
Objective To investigate the hospitalization expense influencing factors covered in the front pages of inpatient medical record. Methods A total of 87, 942 inpatients treated in 12 the tertiary hospitals of Urumuqi city from July 2015 to September 2017 were selected as subjects. The multivariate stepwise regression model was used to analyze the composition of hospitalized disease spectrum and hospitalization expenses in hospitals, then the relationship between hospitalization expenses and hospitalized cases was analyzed in terms of social characteristics,severity, and the hospital diagnosis and treatment quality. Results The hospitalization causes among the selected subjects were dominated by injury and poisoning(16. 94%), followed by respiratory diseases(13. 81%)and digestive diseases(11. 81%). The hospitalization expenses accounted for the largest proportion of all expenses(37. 85%), followed by treatment costs. The hospitalization expenses of elderly patients were higher than those of younger patients, with statistic difference. The hospitalization method, pre-hospitalized condition, number of resuscitation, special nursing, first level nursing, complications, nosocomial infection, operation condition and stay length had significant influence on the hospitalization expenses, furthermore, the expenses were positively correlated with stay length, first level nursing and special nursing days. Conclusions The hospitalization expense influencing factors covered in the front pages of inpatient medical record were found to be stay length, hospitalization method, pre-hospitalized condition, first level nursing and special nursing days, number of resuscitation and age.
Objective To investigate the hospitalization expense influencing factors covered in the front pages of inpatient medical record. Methods A total of 87, 942 inpatients treated in 12 the tertiary hospitals of Urumuqi city from July 2015 to September 2017 were selected as subjects. The multivariate stepwise regression model was used to analyze the composition of hospitalized disease spectrum and hospitalization expenses in hospitals, then the relationship between hospitalization expenses and hospitalized cases was analyzed in terms of social characteristics,severity, and the hospital diagnosis and treatment quality. Results The hospitalization causes among the selected subjects were dominated by injury and poisoning(16. 94%), followed by respiratory diseases(13. 81%)and digestive diseases(11. 81%). The hospitalization expenses accounted for the largest proportion of all expenses(37. 85%), followed by treatment costs. The hospitalization expenses of elderly patients were higher than those of younger patients, with statistic difference. The hospitalization method, pre-hospitalized condition, number of resuscitation, special nursing, first level nursing, complications, nosocomial infection, operation condition and stay length had significant influence on the hospitalization expenses, furthermore, the expenses were positively correlated with stay length, first level nursing and special nursing days. Conclusions The hospitalization expense influencing factors covered in the front pages of inpatient medical record were found to be stay length, hospitalization method, pre-hospitalized condition, first level nursing and special nursing days, number of resuscitation and age.
引文
[1] Wang L, Luhan LI, Zheng Y. Logistic regression analysis on influencing factors of hospitalization expenses with type 2diabetes mellitus in a public hospital in Urumqi[J]. Journal of Xinjiang Medical University,2016, 12(22):156-160.
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[8] Chen M, Song H, Wang JL, et al. Analysis of tuberculosis patients'hospitalization expenses of a middle first-class hospital in Jiangsu province[J]. Modern Preventive Medicine,2017, 31(22):317-319.
[9]宁传英.5000份住院病案首页质量缺陷分析[J].中国病案,2016, 17(11):31-33.
[10]肖涟,李迪,孙扬,等.住院病案首页的质量监控[J].中国病案,2017, 18(1):17-20.
[11] Xiao L, Huang Z, Hu S, et al. Analysis of the Hospitalization Expenses and Influencing Factors of Patients with UterineLeiomyoma Surgery[J]. Chinese Medical Record, 2018,23(37):556-560.
[12]徐锡武,宋景晨,吴锁薇.基于住院病案首页信息的医疗并发症案例特征分析[J].中国病案,2016, 17(7):35-37.
[13] Qian W, Bing S, Xia G, et al. Analysis on influencing factors of hospitalization expenses for patients with congenital heart disease in First Hospital of Lanzhou University from 2011-2015[J]. Occupation&Health, 2018, 35(32):346-350.
[14]李中凯,张淑云,廖原,等.2940例大于2万元的住院费用影响因素分析[J].中国病案,2016, 17(5):57-60.
[15] Sheehy AM, Engel JZ, Cfs L, et al. Hospitalizations With Observation Services and the Medicare Part A Complex Appeals Process at Three Academic Medical Centers[J].Journal of Hospital Medicine, 2017, 12(4):251-255.
[16]韩耀风,高宪利,周莹,等.基于多元逐步回归模型的宫颈癌患者住院费用影响因素分析[J].中国卫生统计,2017,34(2):253-256.
[2]许斌,梁宗敏,李文琦.住院病案首页质量控制[J].中国病案,2017, 18(3):7-9.
[3] Tian R. Analysis on Hospitalization Expenses and Its Influencing Factors of Inpatients with Diabetes Mellitus of a First-Class Hospital in Urumqi City[J]. Medicine&Society,2017, 12(54):444-449.
[4] Zhang X. Analysis of Influence Factors and Control Strategies of Large Hospitalization Expenses of a Children's Hospital in Fuzhou[J]. Medicine&Society, 2017, 21(32):3156-3160.
[5]谢佳东,赵玉凤,胡孔法,等.国内中医住院病案首页质量分析与影响因素初探[J].中国中医药信息杂志,2016,23(12):6-10.
[6]刘涛,李卫红.住院病案首页其他诊断完整性填报质量分析[J].中国病案,2016, 17(7):12-14.
[7] Xu ZQ, Chen X, Deng YX, et al. Influencing factor analysis of hospitalization expense and hospitalization day of soldiers in a navy hospital in the past 9-years[J]. Academic Journal of Second Military Medical University, 2017,38(8):1060-1064.
[8] Chen M, Song H, Wang JL, et al. Analysis of tuberculosis patients'hospitalization expenses of a middle first-class hospital in Jiangsu province[J]. Modern Preventive Medicine,2017, 31(22):317-319.
[9]宁传英.5000份住院病案首页质量缺陷分析[J].中国病案,2016, 17(11):31-33.
[10]肖涟,李迪,孙扬,等.住院病案首页的质量监控[J].中国病案,2017, 18(1):17-20.
[11] Xiao L, Huang Z, Hu S, et al. Analysis of the Hospitalization Expenses and Influencing Factors of Patients with UterineLeiomyoma Surgery[J]. Chinese Medical Record, 2018,23(37):556-560.
[12]徐锡武,宋景晨,吴锁薇.基于住院病案首页信息的医疗并发症案例特征分析[J].中国病案,2016, 17(7):35-37.
[13] Qian W, Bing S, Xia G, et al. Analysis on influencing factors of hospitalization expenses for patients with congenital heart disease in First Hospital of Lanzhou University from 2011-2015[J]. Occupation&Health, 2018, 35(32):346-350.
[14]李中凯,张淑云,廖原,等.2940例大于2万元的住院费用影响因素分析[J].中国病案,2016, 17(5):57-60.
[15] Sheehy AM, Engel JZ, Cfs L, et al. Hospitalizations With Observation Services and the Medicare Part A Complex Appeals Process at Three Academic Medical Centers[J].Journal of Hospital Medicine, 2017, 12(4):251-255.
[16]韩耀风,高宪利,周莹,等.基于多元逐步回归模型的宫颈癌患者住院费用影响因素分析[J].中国卫生统计,2017,34(2):253-256.