武汉市初治涂阳肺结核患者规范化隔离治疗住院费用及治疗效果分析

Analysis of Hospitalization Cost and Treatment Effect of Standardized Quarantine Treatment for Initial Smear Positive Pulmonary Tuberculosis Patients in Wuhan

目的:通过分析相关住院费用及治疗效果以完善初治涂阳肺结核住院治疗方式。方法:选取2016年1月至2017年12月武汉市参与"初治涂阳肺结核患者住院隔离治疗试点项目"的278例患者为项目组,同期未参与项目的同病种患者713例为对照组,通过医院HIS系统、病案首页系统、医疗费用系统获取两组患者相关信息。比较两组患者痰镜检转阴率、平均住院日、住院费用。结果:项目组住院14天痰涂片转阴率71.58%与对照组69.94%,项目组出院前痰涂片转阴率79.14%与对照组71.67%,差异均具有统计学意义(P<0.05);与对照组相比,项目组住院天数、住院总费用、医疗服务费和一次性耗材费中位数更高,差异具有统计学意义(P<0.05)。结论:"初治涂阳肺结核患者住院隔离治疗试点项目"患者平均住院天数更长,平均住院总费用更高,但治疗效果更佳。住院天数是导致项目组住院总费用高的主要原因。多渠道筹资、重视患者健康宣教、提高患者规范化治疗的依从性,可以使结核病的防控工作取得更好的成效。

Objective:To improve the hospitalization treatment of initial smear positive pulmonary tuberculosis patients by analyzing the relevant hospitalization costs and treatment effects.Methods:From January 2016 to December 2017,278 patients who participated in the"Pilot Program for Inpatient Quarantine Treatment of Initial Smear-positive Pulmonary Tuberculosis"in Wuhan were selected as the treatment group,and 713 patients with the same clinical condition who did not participate in the program during the same period were selected as the control group.Data were collected through the HIS system,the home page of the medical record system,and the medical expenses system.The negative rates of sputum microscopy,average length of stay,and hospitalization expenses were compared between the two groups.Results:The sputum smear negative rate of 14 days were 71.58%and 69.94%for treatment group and control group respectively.The sputum smear negative rate before discharging for treatment group was 79.14%and 71.67%for control group,the differences were statistically significant(P<0.05);the median length of stay,total hospitalization expenses,medical service fees and one-time consumables expenses in the treatment group were significantly higher than those in the control group(P<0.05).Conclusion:The average days of stay for patients in the program is longer and the average hospitalization expense is higher,but the treatment effect is better.The number of hospitalization days is the main reason for the high total hospitalization cost of the project team.Through multi-channel fundraising,paying attention to patients health education and improving the patient compliance of standardized treatment,which can achieve better results for the prevention and control of tuberculosis.