基于住院病案首页的高血压肾病患者住院费用有序Logistic回归分析

Status and Influencing Factors of Hospitalization Expenses of Hypertension Kidney Disease: An Analysis with Ordinal Logistic Regression based on Medical Record Front Pages

目的基于住院病案首页分析高血压肾病患者住院费用的影响因素,为完善医疗保障制度、合理分配医疗资源和医疗费用分析提供参考依据。方法对广州某三甲医院2012年1月1日-2017年8月1日516例高血压肾病患者住院费用进行分析,单因素分析采用单因素方差分析、Gamma分析和秩和检验;多因素分析采用有序Logistic回归分析方法。结果2012年-2017年高血压肾病患者住院费用没有统计学差异,平均住院日呈下降趋势,日均住院费用呈上升趋势。有序Logistic回归分析显示高血压肾病患者住院费用的影响因素是手术和操作、抢救、入院途径、住院日、病例分型以及医疗付费方式。结论手术和操作、抢救、入院途径、住院日、病例分型以及医疗付费方式是影响高血压肾病住院费用的影响因素,建议医院优化医疗流程,缩短住院日;患者要及时就医,避免发展为危重病情,导致抢救及透析的发生,达到有效控制住院费用的目的。

Objectives To analyze the factors affecting of hospitalization costs of hospitalization expenses of hypertension kidney disease based on medical record front pages,and provide reference for improving the medical security system,rationally allocating medical resources and analysis of medical expenses.Methods Data on hospitalization expenses of 516 hypertension kidney disease in a consolidated hospital in Guangzhou from January1 st,2012 to August 1 st,2017 were analyzed with one-way ANOVA,Gamma analysis,rank sum test and ordinal logistic regression.Results There was no statistical difference in hospitalization expenses of hypertension kidney disease from 2012 to 2017.The average length of hospital stay showed a downward trend,and daily hospitalization expenses was on the rise.Ordinal logistic regression shawed that the influencing factors of hospitalization expenses of hypertension kidney disease were surgery and operation,rescue,form of hospitalization,hospitalization days,case classification,and health care type.Conclusions Surgery and operation,rescue,form of hospitalization,hospitalization days,case classification,and health care type were the main factors affecting hospitalization expenses of hypertension kidney disease.The study suggested that the hospital should optimize the medical process to shorten the length of stay;the patients should go to the hospital in time accordi ng to the needs of the disease,so as to avoid the development of critical illness,leading to the occurrence of rescue and dialysis,and to achieve the purpose of effectively controlling the inpatient cost.