AECOPD患者住院直接经济负担影响因素分析及相关建议

Analysis of influential factors of direct economic burden of AECOPD patients in hospital and related suggestions

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者住院直接经济负担的影响因素,并提出降低其住院直接经济负担的相关建议。方法收集2019年11月1日-2020年10月31日广州医科大学附属第一医院收治的1923例AECOPD患者的资料,采集其人口社会学特征、临床特征和费用特征信息,运用描述性分析、单因素回归分析、多元线性逐步回归分析探讨影响住院直接经济负担的因素。在查阅文献的基础上,提出降低AECOPD患者住院直接经济负担的相关建议。结果与结论AECOPD患者住院费用的中位值为15621.00元。多元线性逐步回归分析提示,AECOPD患者住院直接经济负担的影响因素从大到小(以偏回归系数排序)依次为住院时间(对数转换值)、转入重症监护室(ICU)、手术治疗、出院转归、是否抢救、使用呼吸机、常见合并症、吸烟史(模型F=572.200,R2=0.750,P<0.001)。建议加强医院综合管理并推进多学科协作,缩短患者住院时间;严格遵循诊疗指南和临床路径,避免患者病情恶化而转入ICU;严格控制手术指征,防止“小病大治”;做好疾病和戒烟宣教,提高患者的自我管理能力。

OBJECTIVE To investigate the influential factors of direct economic burden of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients in hospital,and to provide related suggestions to reduce the direct economic burden of hospitalization. METHODS During Dec. 1 st,2019-Oct. 31 st,2020,the data of 1 923 AECOPD patients admitted into the First Affiliated Hospital of Guangzhou Medical University were collected. The information of demographic sociological characteristics,clinical characteristics and cost characteristics were collected;descriptive analysis,single factor regression analysis and multiple linear stepwise regression analysis were adopted to investigate the influential factors of direct economic burden of hospitalization. On the basis of literature review,relevant suggestions were put forward to reduce the direct economic burden of AECOPD patients in hospital. RESULTS & CONCLUSIONS The median of hospitalization cost of AECOPD patients was 15 621.00 yuan. The multiple linear stepwise analysis regression analysis revealed that the influential factors of direct economic burden of AECOPD patients in descending order(by partial regression coefficient)were the length of stay(logarithmic conversion value),admission to ICU,surgical treatment,discharge outcome,whether to salvage,the use of respirator,common complications and smoking history(model F=572.200,R~2=0.750,P<0.001). It is suggested to strengthen comprehensive hospital management and promote multidisciplinary cooperation to reduce hospitalization days;strictly follow the diagnosis and treatment guidelines and clinical pathways to avoid deterioration of the condition and transfer to ICU treatment;control indications for surgery to avoid“ask for great treatment with only miner illness”;do a good job in the publicity and education of disease and smoking cessation,and improve the self-management ability of patients.