脑梗死患者住院医疗费用及影响因素的通径分析

Path analysis of hospitalization expense and its influencing factors in patients with cerebral infarction

目的探寻影响脑梗死患者住院医疗费用的关键因素,为降低患者疾病经济负担、抑制医疗费用的过快上涨提供参考依据。方法从某三级甲等医院HIS系统收集2 360例主要诊断为脑梗死的出院患者医疗费用明细,描述性分析脑梗死患者基本情况及其医疗费用构成情况,利用多元线性回归模型及通径分析方法探寻影响脑梗死患者住院医疗费用的关键因素。结果影响脑梗死患者医疗费用的关键因素是药品费用及住院天数,而付费方式、是否手术、入院病情、转归情况和出院时期对医疗费用影响次之,并且通过住院天数间接影响住院医疗费用;患者性别、民族、婚姻状况及其年龄仅仅通过影响药品费用来间接地影响住院医疗费用。结论药品费用及其住院天数是影响脑梗死患者医疗费用的关键因素,在控制脑梗死患者医疗费用时,应通过控制其药品使用,在保证疗效的基础上缩短患者住院天数。

Objective To explore the key factors affecting the hospitalization expense of patients with cerebral infarction in an attempt to provide evidence for reducing the economic burden of patient and restraining the rapid increase in health care costs.Method Data on the medical expenditures in 2 360 hospitalized patients with cerebral infarction were retrospectively collected from the HIS system of a tertiary class A hospital.The demographic information of these patients and the compositions of medical expenses were analyzed descriptively.The key factors affecting the hospitalization expenses of patients with cerebral infarction were investigated using multivariate linear regression model and path analysis.Result The key factors affecting the medical expenses of patients with cerebral infarction included drug expenses and hospitalization days,followed by method of payment,surgery,disease condition at admission,patient outcome,and discharge date.Hospitalization days could indirectly affect the drug expenses.Gender,ethnic group,marital status,and age of the patients only had an indirect impact on hospitalization cost by affecting the drug expenses.Conclusion The key factors affecting the medical expenses of patients with cerebral infarction are drug expenses and hospitalization days.Controlling drug prescriptions and shortening hospital stay without compromising therapeutic efficacy may lower the medical expenses of patients with cerebral infarction.