甘肃省2778例肺癌患者住院费用影响因素分析

Determinants of cost of hospitalization: an analysis of 2778 lung cancer patients in Gansu Province

目的：分析2010～2014年甘肃省兰州市某医院肺癌患者的人口学特征、住院费用的构成情况及其影响因素，为减少肺癌患者的住院费用、减轻其经济负担寻找有效的突破口。方法从甘肃省兰州市某三甲医院信息系统（HIS）数据库中提取2010～2014年肺癌患者的基本信息、就医信息及费用信息。运用 Wilcoxon 秩和检验分析5年间及不同特征分组间的费用差异，分别用前进法、后退法和逐步法筛选自变量，运用多重线性回归分析探索有关肺癌患者住院费用的主要影响因素。结果共收集有效病例2778例。西药费和治疗费是过去5年间占总费用比例最大的两项，分别为36．39％和22．46％；住院费用最大的影响因素为住院天数，其次为有无手术、年份和收费方式。结论可通过规范合理用药、改进治疗方案、做好患者心理疏导、健全医疗管理体制、完善医疗资源配置等措施，减少住院天数和降低住院费用，从而减轻甘肃省肺癌患者的经济负担。

Objective To analyze the demographic characteristics,composition characteristics as well as influencing factors of the cost of hospitalization of patients with lung cancer in Gansu Province in order to help reduce their expenses. Methods The basics,healthcare records and expenses of patients diagnosed with lung cancer in a third-level grade-A hospital in Lanzhou were extracted between 2010 and 2014 through the hospital information system（HIS）database.The Wilcoxon rank-sum test was used to analyze the difference of expense composition over the past five years and the difference between subgroups.The forward,backward and stepwise selection method was used to select variables and the multi-linear regression analysis was adopted to explore the influencing factors of the cost of hospitalization.Results A total of 2778 eligible lung cancer patients were collected.The statistical analysis showed that western medicine cost （36.39%）and treatment cost （22.46%）accounted for the most of the total expense.The length of hospital stay was the No.1 influencing factor of the cost of hospitalization,followed by the acceptance of surgery,the year of admission and charge type. Conclusion Regulating drug use,enhancing treatment regimens,giving psychological guidance,strengthening hospital management and improving medical resources allocation may be effective measures to reduce the cost of hospitalization and lighten the economic burden for lung cancer patients in Gansu Province.