基于多水平模型的高血压患者住院费用及其影响因素分析

Analysis of Hospitalization Expenses and Influencing Factors of Hypertension Patients Based on Multilevel Model

目的基于多水平模型分析高血压患者住院费用及影响因素,为完善医疗保障措施提供参考。方法选择2013~2016年某三级甲等综合医院收治的1942例高血压患者作为研究对象,收集患者临床资料,分析高血压患者住院天数及住院费用情况、住院费用构成情况,并采用单因素分析及多水平模型分析住院费用的影响因素,采用Pearson相关性分析住院费用与住院天数的关系。结果2013~2016年,高血压患者的平均住院天数逐年减少,而住院费用总体呈上升趋势。住院总费用中排前4位的分别是西药费、影像学检查费、化验费和诊疗费,占比33.32%、18.14%、17.59%和10.79%,其中西药费占比呈下降趋势,而影像学检查费占比逐年上升。单因素分析显示,不同性别、主管医师级别间住院费用比较,差异无统计学意义(P>0.05);不同住院时间、年龄、医疗付款方式、入院情况、高血压分类、手术情况、合并症情况、出院科室间住院费用比较,差异有统计学意义(P<0.05);Pearson相关性分析显示,住院天数与住院费用呈正相关(r=0.438,P=0.000);多水平模型分析显示,住院时间、出院科室、高血压分类、医疗付款方式、入院情况、手术情况、合并症比况、住院天数是住院费用的影响因素。结论住院费用受多种因素影响,其中西药费、影像学检查费、化验费、诊疗费占比较高,并于住院天数呈正相关关系,而住院时间、出院科室、高血压分类、医疗付款方式、入院情况、手术情况、合并症情况、住院天数与住院费用密切相关,因此在诊疗过程中,合理安排检查和治疗,规范用药,积极治疗原发病及合并症,在保证有效治疗的前提下尽量减少住院天数,可降低患者的住院费用。

Objective To analyze the hospitalization expenses and influencing factors of patients with hypertension based on a multilevel model,and provide a reference for improving medical security measures.Methods 1942 hypertension patients admitted to a tertiary general hospital from 2013 to 2016 were selected as the research objects.The clinical data of the patients were collected,and the hospitalization days,hospitalization expenses,and composition of hospitalization expenses were analyzed by single factor analysis.And a multilevel model was used to analyze the influencing factors of hospitalization expenses,and Pearson correlation was used to analyze the relationship between hospitalization expenses and hospitalization days.Results From 2013 to 2016,the average length of hospitalization for hypertensive patients decreased year by year,while the hospitalization expenses showed an overall upward trend.The top four in the total hospitalization costs are Western medicine,imaging examination fees,laboratory tests and diagnosis and treatment fees,accounting for 33.32%,18.14%,17.59%and 10.79%.The proportion of Western medicine expenses is decreasing,while imaging the proportion of tuition inspection fees has increased year by year.Univariate analysis showed that there was no statistically significant difference in hospitalization expenses between different genders and levels of physicians in charge(P>0.05);different length of stay,age,medical payment methods,admission status,hypertension classification,surgery status,and comorbidities,comparison of hospitalization expenses among discharge departments was statistically significant(P<0.05);Pearson correlation analysis showed that the length of stay was positively correlated with hospitalization expenses(r=0.438,P=0.000);multi-level model analysis showed that length of stay,discharge department,hypertension classification,medical payment method,admission status,surgical status,comorbidity ratio,and length of stay are the influencing factors of hospitalization expenses.Conclusion Hospitalization expenses are affected by many factors,among which western medicine fees,imaging examination fees,laboratory fees,and diagnosis and treatment fees account for a relatively high proportion,and are positively correlated with the number of days of hospitalization.The length of hospitalization,discharge department,hypertension classification,medical payment method,hospital admission,surgery,comorbidities,and length of stay are closely related to hospitalization expenses.Therefore,in the diagnosis and treatment process,reasonable arrangements for examination and treatment,standardized medication,and active treatment of the primary disease and comorbidities,as far as possible under the premise of ensuring effective treatment reducing the number of days in the hospital can reduce the expenses of hospitalization for patients.