基于病例组合制定甲状腺疾病患者住院费用标准的研究

Studying on the standard of hospitalization expenses of inpatients with thyroid disease based on case mix

目的:研究甲状腺疾病患者住院费用及影响因素,进行病例组合分类,制定支付费用标准。方法:筛选哈尔滨市某综合三甲医院2010年1月1日—2010年12月31日期间住院治疗的甲状腺疾病患者,采用多元逐步回归对其住院费用的主要影响因素进行研究,采用决策树中卡方自动互动检验法进行病例组合分类,并计算标准费用。结果:有无其他诊断、年龄、住院天数、入院情况、是否手术是影响甲状腺疾病患者住院费用的主要因素,其中是否手术与住院天数作为有效节点,将患者分为4类不同的病例组合。结论:制定更加合理的费用支付标准以及逐步建立疾病诊断相关分组的结算方式是控制医疗费用的重要途径。

Objective To analyze the hospitalization expenses of inpatients with thyroid disease and its influencing factors, and formulate the standard. Methods Inpatients with thyroid disease hospitalized in a grade three and first-class hospital of Harbin from January to December,2010 were sampled and analyzed with multiple stepwise regression method. The case mix was classified with Chi-squared Automatic Interaction Detector. And the standard expenses were calculated. Results The main factors to influence the hospitalization expenses of inpatients with thyroid disease were diagnosis, age, hospitalized duration, admission condition and surger- y,in which the factors of surgery and hospitalized duration were the active factors to classify the inpatients into four different case- mixes. Conclusion It is suggested to develop more reasonable expense standard and gradually establish payment on diagnosis-related groups for controlling medical expenses.