基于倾向指数匹配的医院感染直接经济损失评价

Evaluation of direct economic loss of nosocomial infection based on propensity score matching

目的采用倾向指数匹配(PSM)法对医院感染直接经济损失进行评价,为医院感染管理提供参考依据。方法选取某医院2015年1月1日-2016年12月31日出院、住院时间>48h且各项资料完整的患者为研究对象,采用PSM获取医院感染患者和非医院感染患者协变量均衡的数据库,并对数据库中患者的住院时间和住院费用进行分析。结果 97.75%的医院感染患者被成功匹配,匹配后,在医院感染患者和非医院感染患者中住院科室差异有统计学意义(P<0.05);全院医院感染患者较非医院感染患者住院时间延长11.00天、住院费用增加18613.45元,差异均有统计学意义(P<0.05),各项费用中以药费7508.42元差异较大,其次为治疗费1561.50元和检查费1493.00元;内科、外科、妇产科、儿科和五官科医院感染所致的额外住院时间和额外住院费用分别为10.00天、14.00天、6.00天、4.00天、13.00天和14664.94元、39960.60元、7704.20元、2036.50元、16082.05元。结论医院感染造成的直接经济损失巨大,不同科室医院感染所致直接经济损失各具特点,应采取有针对性措施降低医院感染风险。

OBJECTIVE To evaluate the direct economic loss of nosocomial infections using propensity score matc- hing （PSM） method, so as to provide basis for management of nosocomial infections. METHODS Patients with complete data and discharged from Jan. 2015 to Dec. 2016 and hospitalization duration 〉48 h were selected for this study. PSM was used to obtain a database of covariate equilibrium between patients with and without nosoco- mial infections. The hospitalization duration （d） and cost （yuan） of the patients in the database were analyzed. RESULTS Totally 97.75% of patients with nosocomial infections were successfully matched. After matching, there were no significantly differences in the distribution of other covariates （P〉0.05） in patients with and without nos- ocomial infection, except in the hospital department （P 〈0.05）. The hospitalization duration and the cost of pa- tients with nosoeomial infections were extended by 11.00 days （P=0.000） and increased by 18613.45 yuan （P〈 0.05） compared with the patients without nosocomial infection. The top 3 additional cost items were costs for medicine （7508.42 yuan）, treatment （1561.50 yuan） and examination （1493.00 yuan）. The extra hospitalization duration and the extra cost caused by nosocomial infection in department of internal medicine, surgery, obstetrics and gynecology, pediatrics and otolaryngology were 10 days, 14 days, 6 days, 4 days, 13 days and 14664.94 yuan, 39960.60 yuan, 7704.20 yuan, 2036.50 yuan, 16082.05 yuan, respectively. CONCLUSION The nosocomial infections can cause huge direct economic loss. The direct economic losses caused by different departments are dif- ferent. It is necessary to take effective measures to reduce the risk of nosocomial infections.