利用边际医疗费用原理对某院平均住院日分析

Analysis on the Average Hospitalization Days of a Hospital by Marginal Medical Cost Principle

目的通过边际医疗费用原理对全院平均住院日进行分析,为进一步缩短平均住院日提供参考。方法从某院病案首页信息管理系统中检索2015年-2016年2年出院患者的基本信息,按照住院天数分成21个时间组,计算患者边际住院总费用、边际床位费、边际西药费、边际检查费和边际手术费,利用边际医疗费用原理了解住院天数的高效期、低效期与无效期,并进一步探讨无效期的相关科室的病种。结果男性患者的平均住院日高于女性(χ~2=735.45,P<0.0001);年龄越大的患者平均住院日越长(χ~2=5534.84,P<0.0001);省内患者的平均住院日高于省外(χ~2=312.62,P<0.0001);非自费患者的平均住院日高于自费患者(χ~2=3338.67,P<0.0001);有手术/操作患者平均住院日高于无手术/操作患者(χ~2=1472.64,P<0.0001);患者住院天数≤15天,边际费用持续增长,为高效住院日,住院天数在16天~39天,边际费用开始下降,为低效住院日,住院天数≥40天,边际费用出现负值,为无效住院日;在无效住院日中,以放疗科的影响健康状态和与保健机构接触的因素和肿瘤所占比例最高。结论医院管理层应对无效住院日的各个科室的病种进行重点管理,进一步缩短平均住院日,保证医院高效运转,避免不必要的医疗资源浪费。

Objectives To analyze of average hospitalization days by marginal medical cost principle, and provide a reference for further shortening the average length of stay. Methods The basic information of discharged patients from 2015 to 2016 were retrieved from the front pages of the medical records. The patients were divided into 21 groups in accordance with their different hospitalization days to analyze their marginal total cost of the hospitalization, marginal bed fees, marginal medicine fees, marginal check fees and marginal surgery fees. Using the principle of marginal medical cost to understand the period of validity and invalidation of the length of hospital days, and further explore the ineffective period＇s relevant departments-disease. Results The length of average hospitalization days for male patients were higher than female （χ2=735.45, P〈0. 0001）. The older patients＇ average hospital days were longer （χ2=5534.84, P〈0. 0001）. The average hospitalization stay in the province were higher than out of the province χ2=312.62, P〈0. 0001）. The average hospital days were higher in not self-funded patient than the patients at their own expense （χ2=3338.67, P〈0. 0001）. Patients with surgery or operation had an averagehospital stay higher than those without surgery or operation （χ2=1472.64, P〈0. 0001）. When hospitalization within 15 days, the patients belongs to the high hospitalization days, with the marginal medical costs continually growing. And the patients of hospitalization in 16 to 39 days were the inefficient hospital days with the marginal medical costs continually decreasing. The patients stayed the invalid hospitalization stage after 40 days because the marginal medical costs appeared negative growth. In the invalid hospitalization, the highest proportion were radiotherapy-factors influencing health status and contacted with health services and radiotherapy-neoplasms. Conclusions The hospital management should be focus on management the invalid hospitalization of the department-diseases, so as to further reduce the average hospitalization days, ensure the hospital＇s effective operation and avoid unnecessary waste of medical resources.