影响临床路径卫生经济学指标的多因素分析

Multivariate analysis on impacting medical economic indicators of clinical pathway

目的:探讨临床路径住院费用的关键影响因素,为制定有效控制住院费用的方案提供参考依据。方法:查阅文献后选择待分析的18项影响因素,抽取2011年4月至10月实施临床路径的214例患者病历,收集并记录来自于医院内部、患者自身、疾病转归三大方面18项影响指标的具体情况,进行多因素Logistic回归分析后确定影响临床路径住院费用的关键指标。结果:经二分类变量的Logistic回归分析,抗生素使用不合理(P=0.000,OR=6.615)、检查超出规定范围(P=0.027,OR=3.585)、患者拒绝出院(P=0.003,OR=5.218),发生并发症(P=0.004,OR=6.171)、药占比高(P=0.034,OR=3.486)、合并基础疾病(P=0.004,OR=8.106)共6个因素最终进入回归模型方程。结论:临床路径住院费用受到多因素影响,抗生素使用不合理、检查超出规定范围、患者拒绝出院、发生并发症、药占比高、合并基础疾病可能是影响临床路径卫生经济学指标的关键因素。

Objectives：To explore the key factors that affect hospital expense of clinical pathway and to provide references for the effective control hospital expense. Methods：Based on literature review, 18 factors were selected. 214 cases of patients’ records who was brought into clinical pathways management from April to October 2011were selected and the 18 indicators in three aspects of hospital, patient and disease prognosis were collected. Multivariate logistic regression analysis was used to determine the key indicators influencing hospital expense of clinical pathway. Results： According to binary variable Logistic regression analysis, irrational use of antibiotics（P=0.000,OR= 6.615）, examinations out of range（P=0.027,OR=3.585）, patients refused to discharge（P=0.003,OR=5.218）, complications（P=0.004,OR=6.171）, high drug proportion（P=0.034,OR=3.486）, within underlying diseases（P=0.004,OR=8.106）eventually entered into the regression model equation. Conclusions： Multiple factors affect hospital expense of clinical pathway, irrational use of antibiotics, examinations out of range, patients refused to discharge, complications, high drug proportion, within underlying diseases may be the key indicators of the health economics in clinical pathway.