剖宫产住院费用的影响因素及病例组合管理模式分析
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摘要
目的探讨剖宫产产妇住院费用的影响因素及不同病例组合下的费用控制。方法对2000年1月至2017年12月广州市某三甲医院剖宫产手术的8080例产妇病案首页数据进行Logistic、决策树和病例组合分析。结果根据Logistic回归分析和决策树分析结果,用住院天数、药占比、妊娠合并疾病、患者来源和参保情况共5个变量进行剖宫产住院费用的预测,预测准确率为70.58%。形成8种病例组合情况,筛选出超额费用患者483例,占5.98%。结论合理控制住院天数、合理用药监管及参保管理是降低剖宫产住院费用的可行措施;病例组合方法对于剖宫产产妇住院费用的管理和控制有积极的意义。
Objective To discuss influence factors of hospitalization expenses of cesarean delivery and cost control under different case combinations. Methods Medical records of cesarean delivery women from a tertiary hospital during Jan 2000 and Dec 2017 in Guangzhou city were analyzed using logistic regression, decision tree and case combination analysis. Results According to the Results of Logistic analysis and decision tree analysis,hospitalization days, drug proportion, pregnancy complicated with disease, places coming from and insurance were used to do the prediction of hospital expenses of cesarean delivery with predict accuracy 70.58%. 8 case combinations were formed, screened out the excess charges in 483 cases, accounted for 5.98%. Conclusion Appropriate of reducing hospitalization days, supervising drug-use and insurance management are feasible measures for reducing hospitalization expenses of cesarean delivery women. Case combination method has positive influences for hospitalization expenses control of cesarean delivery women.
Objective To discuss influence factors of hospitalization expenses of cesarean delivery and cost control under different case combinations. Methods Medical records of cesarean delivery women from a tertiary hospital during Jan 2000 and Dec 2017 in Guangzhou city were analyzed using logistic regression, decision tree and case combination analysis. Results According to the Results of Logistic analysis and decision tree analysis,hospitalization days, drug proportion, pregnancy complicated with disease, places coming from and insurance were used to do the prediction of hospital expenses of cesarean delivery with predict accuracy 70.58%. 8 case combinations were formed, screened out the excess charges in 483 cases, accounted for 5.98%. Conclusion Appropriate of reducing hospitalization days, supervising drug-use and insurance management are feasible measures for reducing hospitalization expenses of cesarean delivery women. Case combination method has positive influences for hospitalization expenses control of cesarean delivery women.
引文
[1]李红,马立旭,康楠.2007年-2013年剖宫产住院费用灰色关联分析[J].中国病案,2014,15(10):54-56.
[2]薛允莲. logistic回归结合决策树技术在冠心病患者住院费用组合分析中的应用[J].中国卫生统计,2015,32(6):988-992.
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[4]刘丹红,徐勇勇,胡湖.病例组合及其在病种费用管理中的应用[J].中国卫生经济,2003,22(12):51-53
[5]付晓萌,刘媛媛,刘晓倩,等.天津市参保急性心肌梗死患者住院费用分析及病例组合初探[J].中国卫生统计,2015,32(3):383-385.
[6]陈霞,许剑.孕期保健对高龄产妇并发症及妊娠结局的影响[J].中国妇幼保健,2015,30(4):536-538.
[7]袁继梅,张宁.剖宫产住院费用构成及影响因素分析[J].中国卫生统计,2017,34(3):490-491.
[8]魏敦灿,王亚力,刘元生,等.233例剖宫产住院总费用的影响因素分析[J].汕头大学医学院学报,2015(3):166-167.
[9]肖煜吟,李国红,张军.上海市产妇住院分娩费用影响因素分析[J].上海交通大学学报(医学版),2018,38(3):323-327.
[10]夏军芳,曹秀玲,徐凌忠,等.山东省某医院剖宫产住院费用变化及影响因素分析[J].中国卫生经济,2015,34(7):68-70.
[11]李鹤梅,石民彦.按DRGs制定剖宫产患者住院费用标准的研究[J].中国医疗保险,2015(12):52-54.
[12]袁继梅,张宁.剖宫产手术住院费用构成及影响因素分析[J].中国病案,2015(5):42-44.
[13]李士臻,计立群,宁岩,等.辽宁省县级公立医院改革对医院收入和服务影响分析[J].中国医院管理,2017,37(6):8-13.
[14]Cai W W, Mark J S, Chen C H, et a1. Increased cesareansection rates and emerging patterns of health insurance inShanghai,China[J].AmJPublicHealth,1998,88(5):777-780.
[15]董琬月,杨金娟,柏如海,等.公立医院临床住院科室绩效考核方案的设计[J].中国医院管理,2016,36(4):52-54.
[16]张瑞迪.公立医院实施病例组合指数绩效评价的应用探讨[J].中国医院管理,2016,36(3):43-45.
[2]薛允莲. logistic回归结合决策树技术在冠心病患者住院费用组合分析中的应用[J].中国卫生统计,2015,32(6):988-992.
[3]胡向阳,王原,张修梅.病例组合概念及其应用[J].中华医院管理杂志,1994,10(12):736-739.
[4]刘丹红,徐勇勇,胡湖.病例组合及其在病种费用管理中的应用[J].中国卫生经济,2003,22(12):51-53
[5]付晓萌,刘媛媛,刘晓倩,等.天津市参保急性心肌梗死患者住院费用分析及病例组合初探[J].中国卫生统计,2015,32(3):383-385.
[6]陈霞,许剑.孕期保健对高龄产妇并发症及妊娠结局的影响[J].中国妇幼保健,2015,30(4):536-538.
[7]袁继梅,张宁.剖宫产住院费用构成及影响因素分析[J].中国卫生统计,2017,34(3):490-491.
[8]魏敦灿,王亚力,刘元生,等.233例剖宫产住院总费用的影响因素分析[J].汕头大学医学院学报,2015(3):166-167.
[9]肖煜吟,李国红,张军.上海市产妇住院分娩费用影响因素分析[J].上海交通大学学报(医学版),2018,38(3):323-327.
[10]夏军芳,曹秀玲,徐凌忠,等.山东省某医院剖宫产住院费用变化及影响因素分析[J].中国卫生经济,2015,34(7):68-70.
[11]李鹤梅,石民彦.按DRGs制定剖宫产患者住院费用标准的研究[J].中国医疗保险,2015(12):52-54.
[12]袁继梅,张宁.剖宫产手术住院费用构成及影响因素分析[J].中国病案,2015(5):42-44.
[13]李士臻,计立群,宁岩,等.辽宁省县级公立医院改革对医院收入和服务影响分析[J].中国医院管理,2017,37(6):8-13.
[14]Cai W W, Mark J S, Chen C H, et a1. Increased cesareansection rates and emerging patterns of health insurance inShanghai,China[J].AmJPublicHealth,1998,88(5):777-780.
[15]董琬月,杨金娟,柏如海,等.公立医院临床住院科室绩效考核方案的设计[J].中国医院管理,2016,36(4):52-54.
[16]张瑞迪.公立医院实施病例组合指数绩效评价的应用探讨[J].中国医院管理,2016,36(3):43-45.