胃癌患者住院费用及影响因素分析
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摘要
目的:了解胃癌患者住院费用的主要影响因素,为减轻患者的经济负担提供科学依据。方法:收集大连市2012年1月1日至2017年12月31日出院且主要诊断为胃癌的患者病历资料,采用多元回归分析拟合通径分析模型,研究影响胃癌患者住院费用的直接因素和间接因素。结果:胃癌患者的人均住院天数16.49天,人均住院费用为37 896.21元。通径分析结果显示,年龄、出院年份、有无合并症、是否手术和付费方式对住院费用既有直接影响,同时还通过住院天数从而对住院费用有间接影响。结论:是否手术是影响胃癌患者住院费用的最主要因素,其次是住院天数,应采取综合有效的措施,如实施临床路径、对患者进行合理引流等,控制住院费用的过快增长,减轻患者的经济负担。
Objective: To understand the main factors influencing hospitalization expenses of gastric cancer patients and provide scientific basis for reducing the economic burden of patients. Methods: Medical records of patients who were diagnosed with gastric cancer and were discharged during 2012-2017 in Dalian were collected. Multivariate regression analysis was used to fit the recursive model and path analysis was conducted to study the direct and indirect factors affecting the hospitalization expenses of gastric cancer inpatients. Results: The average length of hospitalization was 16.49 days and the average hospitalization cost was 37 896.21 yuan. Path analysis showed that among all the influencing factors, age, discharge year, complications, operation and payment method had direct impact on hospitalization expenses, and indirect impact on hospitalization expenses through hospitalization days. Conclusion: Surgery was the most important factor affecting the hospitalization expenses of gastric cancer patients, followed by the length of hospitalization.In order to control the hospitalization expenses of gastric cancer patients effectively and reduce the economic burden of patients, some effective measures should be taken, such as the implementation of clinical pathways and rational drainage of patients.
Objective: To understand the main factors influencing hospitalization expenses of gastric cancer patients and provide scientific basis for reducing the economic burden of patients. Methods: Medical records of patients who were diagnosed with gastric cancer and were discharged during 2012-2017 in Dalian were collected. Multivariate regression analysis was used to fit the recursive model and path analysis was conducted to study the direct and indirect factors affecting the hospitalization expenses of gastric cancer inpatients. Results: The average length of hospitalization was 16.49 days and the average hospitalization cost was 37 896.21 yuan. Path analysis showed that among all the influencing factors, age, discharge year, complications, operation and payment method had direct impact on hospitalization expenses, and indirect impact on hospitalization expenses through hospitalization days. Conclusion: Surgery was the most important factor affecting the hospitalization expenses of gastric cancer patients, followed by the length of hospitalization.In order to control the hospitalization expenses of gastric cancer patients effectively and reduce the economic burden of patients, some effective measures should be taken, such as the implementation of clinical pathways and rational drainage of patients.
引文
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[12] SO J B,LIM Z L, LIN H A,et al. Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer[J]. Gastric cancer,2008,11(2):81-85.
[13]魏亚卿,李育民,裴正学,等.胃癌患者住院费用及影响因素的通径分析[J].中国肿瘤,2018,27(8):596-600.
[14]肖梦,冯向先,张云兵,等.山西省2003—2012年胃癌患者住院费用影响因素分析[J].中国公共卫生,2015,31(10):1330-1333.
[15]张飞,王文杰,李琛,等.陕西省新型农村合作医疗费用负担和补偿情况分析[J].中国卫生经济,2018,37(8):42-44.
[16]杨耀淞,孙常洁,梁超,等.不同医保类型脑出血患者住院费用影响因素综合分析[J].中国卫生经济,2017,36(5):26-28.
[17] CASTRO F, SHAHAL D, TARAJIA M, et al. Baseline characteristics, survival and direct costs associated to treatment of gastric cancer patients at the National Oncology Institute of Panama from 2012 to 2015:a hospital-based observational study[J]. Bmj open, 2017,7(9):e017266.
[18] YABROFF K R, LAMONT E B, MARIOTTO A, et al. Cost of care for elderly cancer patients in the United States[J]. J natl cancer inst, 2008,100(9):630-641.
[19] JR GUY P G,EKWUEME D U, YABROFF K R, et al. Economic burden of cancer survivorship among adults in the United States.[J]. Journal of clinical oncology, 2013,31(30):3749-3757.
[20] SONG Z, WU Y, YANG J, et al. Progress in the treatment of advanced gastric cancer.[J]. Tumour biology the journal of the international society for oncodevelopmental biology&medicine, 2017,39(7):1010428317714626.
[2] RANJBAR M, SIAMIAN H, FALLAHPOUR M J. Study on the quality of life among the cancer patients at the sari comprehensive cancer center in 2017[J]. Materia socio-medica,2018,30(2):127-130.
[3]郑荣寿,顾秀瑛,李雪婷,等. 2000—2014年中国肿瘤登记地区癌症发病趋势及年龄变化分析[J].中华预防医学杂志,2018(6):593-600.
[4]陈万青,李贺,孙可欣,等. 2014年中国恶性肿瘤发病和死亡分析[J].中华肿瘤杂志,2018(1):5-13.
[5]姚芳,石春雷,刘成成,等.中国1996—2015年胃癌经济负担研究的系统评价[J].中华预防医学杂志,2017(8):756-762.
[6]魏亚卿,李育民,王晓茹,等.糖尿病患者住院费用及影响因素的通径分析[J].中国卫生经济,2018,37(4):67-70.
[7]陈治水,冷家骅,高广颖,等.五类肿瘤疾病住院费用及其影响因素分析[J].中国卫生经济,2014,33(7):57-60.
[8] IZADI A, SIRIZI M J, ESMAEELPOUR S, et al. Evaluating direct costs of gastric cancer treatment in Iran—case study in Kerman City in 2015[J]. Asian pacific journal of cancer prevention apjcp, 2016,17(6):3007.
[9] MAHAR A L, ELSEDFY A, BRAR S S, et al. Are we lacking economic evaluations in gastric cancer treatment?[J]. Pharmacoeconomics, 2015,33(2):83-87.
[10]董兵斌,徐阿曼.胃癌手术风险及影响因素研究现状[J].中国肿瘤临床,2015,42(2):125-128.
[11]贺志敏,李芬,金春林,等.上海市恶性肿瘤患者的终末期住院费用影响因素[J].中南大学学报(医学版),2018,43(1):68-75.
[12] SO J B,LIM Z L, LIN H A,et al. Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer[J]. Gastric cancer,2008,11(2):81-85.
[13]魏亚卿,李育民,裴正学,等.胃癌患者住院费用及影响因素的通径分析[J].中国肿瘤,2018,27(8):596-600.
[14]肖梦,冯向先,张云兵,等.山西省2003—2012年胃癌患者住院费用影响因素分析[J].中国公共卫生,2015,31(10):1330-1333.
[15]张飞,王文杰,李琛,等.陕西省新型农村合作医疗费用负担和补偿情况分析[J].中国卫生经济,2018,37(8):42-44.
[16]杨耀淞,孙常洁,梁超,等.不同医保类型脑出血患者住院费用影响因素综合分析[J].中国卫生经济,2017,36(5):26-28.
[17] CASTRO F, SHAHAL D, TARAJIA M, et al. Baseline characteristics, survival and direct costs associated to treatment of gastric cancer patients at the National Oncology Institute of Panama from 2012 to 2015:a hospital-based observational study[J]. Bmj open, 2017,7(9):e017266.
[18] YABROFF K R, LAMONT E B, MARIOTTO A, et al. Cost of care for elderly cancer patients in the United States[J]. J natl cancer inst, 2008,100(9):630-641.
[19] JR GUY P G,EKWUEME D U, YABROFF K R, et al. Economic burden of cancer survivorship among adults in the United States.[J]. Journal of clinical oncology, 2013,31(30):3749-3757.
[20] SONG Z, WU Y, YANG J, et al. Progress in the treatment of advanced gastric cancer.[J]. Tumour biology the journal of the international society for oncodevelopmental biology&medicine, 2017,39(7):1010428317714626.