海军某医院9年军人住院费用及住院日影响因素分析

Influencing factor analysis of hospitalization expense and hospitalization day of soldiers in a navy hospital in the past 9-years

目的分析海军某三级甲等医院9年间军人住院费用及住院日的变化趋势及其影响因素,为军队医院卫生资源配置提供决策依据。方法从海军某三级甲等医院军卫系统提取2008年1月-2016年12月住院并接受治疗的16 278例军人患者资料。采用描述性分析、Mann-Whitney U检验、Kruskal-Wallis H检验等方法分析住院费用与住院日现状、变化趋势及影响因素。结果军人患者入院年龄平均为(28.33±13.40)岁。2008-2016年间住院日呈现缩短趋势,住院费用呈现增长趋势。对可能影响住院费用的影响因素进行分析,结果显示军种、病情、入院次数、乙肝表面抗原、丙肝抗体、人免疫缺陷病毒抗体、军职、年龄、转归等多分类变量均有统计学意义(P<0.05),病重、病危、入住ICU、特级护理、一级护理、过敏、手术等二分类变量均有统计学意义(P<0.05);对可能影响住院日的影响因素进行分析,结果显示军种、病情、入院次数、人免疫缺陷病毒抗体、军职、年龄、转归等多分类变量均有统计学意义(P<0.05),性别、病重、病危、特级护理、一级护理、手术等二分类变量均有统计学意义(P<0.05)。结论军人患者住院日的逐渐降低和住院费用的不断升高反映了医疗技术的不断进步和住院管理效率的不断提高,但也面临医疗成本不断增加的压力。从成本效益角度,建议加强分级转诊,控制住院费用与住院日。

Objective To explore the variation tendency and influencing factors of the hospitalization costs and hospital day of soldiers in a navy hospital,so as to provide reference for the health resource allocation of military hospitals.Methods The data of 16 278 military patients who were hospitalized and treated from Jan.2008 to Dec.2016 were extracted from the military health system.The hospitalization costs and status,variation tendency and influencing factors of hospital stay were analyzed by descriptive analysis,Mann-Whitney U test and Kruskal-Wallis H test.Results The average age of admission was（28.33±13.40）years,and the hospitalization period showed a shortening trend,while the hospitalization costs showed an increasing trend during 2008-2016.The polytomous variables,including services,patient＇s condition, hospitalized times, hepatitis B surface antigen, hepatitis C antibody, human immunodeficiency virus（HIV）antibody,military appointment,age and outcomes,and the dichotomous variables,including severe condition,critical condition,ICU admission,special-grade nursing care,first-grade nursing care,allergies and operation,were the influencing factors of hospitalization expenses（P〈0.05）.The polytomous variables,including services,patient＇s condition,hospitalized times,HIV antibody,military appointment,age and outcomes,and the dichotomous variables,including gender,severe condition,critical condition,special-grade nursing care,first-grade nursing care and operation,were the influencing factors of hospitalization stay（P〈0.05）.Conclusion The decreasing hospitalization day of military patients and increasing hospitalization costs suggest that the medical technology and hospital management efficiency are continuously improving,but facing the pressure of increasing medical costs.From a cost-effective perspective,we should strengthen the graded referral and control hospitalization costs and length of hospital stay.