冠心病经皮冠状动脉介入治疗患者住院费用影响因素分析

ANALYSIS OF INFLUENCING FACTORS FOR HOSPITAL COSTS IN PATIENTS WITH CORONARY HEART DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

目的分析冠心病经皮冠状动脉介入(PCI)治疗患者住院费用的影响因素,以便能够合理控制患者的住院费用。方法收集我院2019年1月—2020年12月经PCI治疗的冠心病患者临床资料,采用单因素分析联合结构方程模型的方法,探讨各影响因素对患者住院费用的影响情况。结果经PCI治疗的冠心病患者住院费用中位数为45273元,其中材料费占比最高,结构方程模型显示,支架数量、住院时间、合并其他操作和是否输血对住院费用影响的总效应和直接效应较大;主要诊断和查尔森合并症指数通过住院时间对住院费用影响的间接效应较大;付费方式和年龄对住院费用的影响效应较小。结论应规范手术临床路径管理,加强对科室绩效考核,同时扩大高值耗材集采范围,加强冠心病合并症的管理,以降低患者住院费用。

Objective To investigate the influencing factors for hospital costs in patients with coronary heart disease undergoing percutaneous coronary intervention(PCI),and to provide a reference for reasonable control of hospitalization costs in such patients.Methods Clinical data were collected from the patients with coronary heart disease who received PCI in our hospital from January 2019 to December 2020,and a univariate analysis and a structural equation model were used to investigate the in-fluence of each influencing factor on hospital costs.Results The median hospital costs were 45273 yuan for the patients with coronary heart disease undergoing PCI,among which material costs accounted for the highest proportion.The structural equation model showed that the number of stents,length of hospital stay,combination with other operations,and blood transfusion had greater total and direct effects on hospital costs.Main diagnosis and Charlson Comorbidity Index had a greater indirect effect on hospital costs through the length of hospital stay.Payment method and age had a smaller effect on hospital costs.Conclusion Hospital costs can be reduced by standardizing the management of surgical clinical pathway,enhancing the performance assessment of departments,expanding the scope of centralized procurement of high-value consumables,and strengthening the management of coronary heart disease comorbidities.