脑卒中患者住院费用影响因素的通径分析
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摘要
目的探讨影响脑卒中患者住院费用的主要因素,为合理控制医疗费用的过快增长、减轻患者的经济负担提供参考。方法回顾性分析2007年1月至2014年12月出院的安徽省某三甲医院8 585例主要诊断为脑卒中患者的病案资料,采用通径分析研究影响其住院费用的直接因素和间接因素。结果住院日是直接影响脑卒中患者住院费用的首要因素;疾病类型、患者来源、手术情况、年龄以及出院转归在直接影响住院费用的同时,还通过住院日对住院费用存在间接影响,而住院日、性别、入院病情以及出院年份对住院费用仅存在直接作用。结论控制脑卒中患者住院费用要以缩短平均住院日为突破口,采取综合措施,控制可控因素,有效缓解医疗费用的不合理增长,减轻患者和社会的经济负担。
Objective To explore the pertinent factors on hospitalization expenses of patients with stroke,aiming to provide the theoretic evidence for reasonably controlling the over- increased growth of medical costs and diminishing the financial burden of patients. Methods The clinical data of 8585 patients with primary diagnosis of stroke at a certain tertiary hospital in Anhui Province from January 2007 to December 2014 was collected retrospectively,and the pathway analysis method was applied to analyze the direct and indirect influencing factors of medical costs. Results The length of hospital stay was the critical factor affecting hospitalization costs of patients with stroke directly. Disease types,patients' source,age,surgical operation and the condition at discharge did not only have direct effects,but also indirect effects on hospitalization expenses. While the length of hospital stay,gender,the condition at the moment of admission and the year of medical treatment only influenced the hospitalization costs directly. Conclusion Shortening the length of hospital stay may be considered as a potential breakthrough to control the medical expenses of patients with stroke,meanwhile the comprehensive steps should be taken and the controllable factors were strengthened,to relief the unaffordable medical costs and alleviate the economic burden of the society and patients with stroke.
Objective To explore the pertinent factors on hospitalization expenses of patients with stroke,aiming to provide the theoretic evidence for reasonably controlling the over- increased growth of medical costs and diminishing the financial burden of patients. Methods The clinical data of 8585 patients with primary diagnosis of stroke at a certain tertiary hospital in Anhui Province from January 2007 to December 2014 was collected retrospectively,and the pathway analysis method was applied to analyze the direct and indirect influencing factors of medical costs. Results The length of hospital stay was the critical factor affecting hospitalization costs of patients with stroke directly. Disease types,patients' source,age,surgical operation and the condition at discharge did not only have direct effects,but also indirect effects on hospitalization expenses. While the length of hospital stay,gender,the condition at the moment of admission and the year of medical treatment only influenced the hospitalization costs directly. Conclusion Shortening the length of hospital stay may be considered as a potential breakthrough to control the medical expenses of patients with stroke,meanwhile the comprehensive steps should be taken and the controllable factors were strengthened,to relief the unaffordable medical costs and alleviate the economic burden of the society and patients with stroke.
引文
[1]Kaur P,Kwatra G,Kaur R,et al.Cost of stroke in low and middle income countries:a systematic review[J].International journal of stroke:official journal of the International Stroke Society,2014,9(6):678-682.
[2]Snozzi P,Blank PR,Szucs TD.Stroke in Switzerland:social determinants of treatment access and cost of illness[J].Journal of stroke and cerebrovascular diseases:the official journal of National Stroke Association,2014,23(5):926-932.
[3]孔祥辉,刘丹,卢志刚,等.荆门市居民脑卒中流行现状及危险因素调查[J].现代预防医学,2015,42(10):1736-1738.
[4]芦燕玲,潘伟琦.老年高血压患者幽门螺杆菌感染与新发心脑血管事件关系的研究[J].中华老年心脑血管病杂志,2015,17(2):130-132.
[5]安徽省统计局.安徽统计年鉴-2014[EB/OL].[2015-10-20].http://www.ahtjj.gov.cn/tjj/tjnj/2014/2014.html.
[6]杨梅,肖静,陈德喜,等.8288例食管癌患者住院费用影响因素的通径分析[J].现代预防医学,2013,40(5):801-803,807.
[7]杨辉,冯向先,李韶霞.消化系统肿瘤患者住院费用影响因素的通径分析[J].现代预防医学,2014,41(14):2566-2568,2577.
[8]胡丹,董峻,朱靖,等.2007-2011年某三甲医院脑梗死住院费用构成及影响因素分析[J].中国卫生统计,2014,31(4):707-709.
[9]万宇,张俊.影响缺血性卒中患者住院总天数及费用的相关因素分析[J].实用医学杂志,2014,30(9):1420-1423.
[10]周继光,Liu WP.子宫肌瘤手术患者住院费用通径分析[J].中国卫生经济,2013,32(6):76-78.
[11]杜连连,魏巍,谢学勤,等.脑梗死患者住院费用及影响因素的通径分析[J].中国全科医学,2014,17(1):71-74.
[12]黄晶,魏秀红,吴炳义,等.我国居民住院总费用影响因素的通径分析[J].中国卫生事业管理,2014,31(2):86-87,124.
[13]李兰翠,孙志明,巫嘉陵,等.天津市三级医疗机构脑卒中患者住院费用研究[J].中国慢性病预防与控制,2015,23(6):431-435.
[2]Snozzi P,Blank PR,Szucs TD.Stroke in Switzerland:social determinants of treatment access and cost of illness[J].Journal of stroke and cerebrovascular diseases:the official journal of National Stroke Association,2014,23(5):926-932.
[3]孔祥辉,刘丹,卢志刚,等.荆门市居民脑卒中流行现状及危险因素调查[J].现代预防医学,2015,42(10):1736-1738.
[4]芦燕玲,潘伟琦.老年高血压患者幽门螺杆菌感染与新发心脑血管事件关系的研究[J].中华老年心脑血管病杂志,2015,17(2):130-132.
[5]安徽省统计局.安徽统计年鉴-2014[EB/OL].[2015-10-20].http://www.ahtjj.gov.cn/tjj/tjnj/2014/2014.html.
[6]杨梅,肖静,陈德喜,等.8288例食管癌患者住院费用影响因素的通径分析[J].现代预防医学,2013,40(5):801-803,807.
[7]杨辉,冯向先,李韶霞.消化系统肿瘤患者住院费用影响因素的通径分析[J].现代预防医学,2014,41(14):2566-2568,2577.
[8]胡丹,董峻,朱靖,等.2007-2011年某三甲医院脑梗死住院费用构成及影响因素分析[J].中国卫生统计,2014,31(4):707-709.
[9]万宇,张俊.影响缺血性卒中患者住院总天数及费用的相关因素分析[J].实用医学杂志,2014,30(9):1420-1423.
[10]周继光,Liu WP.子宫肌瘤手术患者住院费用通径分析[J].中国卫生经济,2013,32(6):76-78.
[11]杜连连,魏巍,谢学勤,等.脑梗死患者住院费用及影响因素的通径分析[J].中国全科医学,2014,17(1):71-74.
[12]黄晶,魏秀红,吴炳义,等.我国居民住院总费用影响因素的通径分析[J].中国卫生事业管理,2014,31(2):86-87,124.
[13]李兰翠,孙志明,巫嘉陵,等.天津市三级医疗机构脑卒中患者住院费用研究[J].中国慢性病预防与控制,2015,23(6):431-435.