某部队三甲医院2016~2020年骨折军队伤病员住院总费用变化趋势及影响因素研究

Study on the Change Trend and Influencing Factors of the Total Hospitalization Expenses of Wounded and Sick Military Casualties with Fractures from 2016 to 2020 in a Tertiary Hospital of a Troop

目的 探讨某部队三甲医院2016~2020年骨折军队伤病员住院总费用的变化趋势及其影响因素,为该院合理调控军队伤病员住院费用的增长提供依据。方法 通过作者医院信息系统(hospital information system, HIS)提取2016-01-01/2020-12-31日出院的骨折军队伤病员基本信息、临床信息和住院费用信息,利用结构变动度分析法分析军队伤病员住院总费用的变化趋势,利用多元线性回归模型分析影响军队伤病员住院总费用的因素。结果 2016~2020年该院骨折军队伤病员住院人均住院费用几何均值为25 885.61元,总体呈现住院总费用随时间下降的趋势(β=-4.281,P<0.001)。2016~2020年该院骨折军队伤病员住院医疗费用结构变动度为56.17%,年均结构变动度为18.68%,其中结构变动度贡献率前三项单项费用依次是西药费(24.03%),耗材费(22.16%)和单纯诊疗费(19.46%),三者的累计贡献率达65.65%。多元回归分析提示,医院骨折军队伤病员住院医疗总费用的影响因素包括:入院年份、离院方式、手术、输血、西药治疗、中成药治疗、年龄和住院天数。结论 合理调控军队伤病员住院总费用的增长,一方面需要优化住院费用内部结构,另一方面通过精选治疗方案,控制住院天数等途径来实现。

Objective To study the changing trend and influencing factors of the total hospitalization expenses of the fractured military wounded and sick in a tertiary hospital of a troop from 2016 to 2020, and to provide a basis for anthor′s hospital to better and rationally control the increase in hospitalization expenses of military wounded and sick. Methods The basic information, clinical information and hospitalization expenses information of the military wounded and sick with fractures discharged from author′s hospital from January 1, 2016 to December 31, 2020 were extracted by the hospital information system(HIS), the change trend of the total hospitalization expenses of the military wounded and sick was analyzed by the structural change analysis method, and the influencing factors which affected the total hospitalization expenses of the military wounded and sick were explored by a multiple linear regression model. Results From 2016 to 2020, after adjusting for inflation, the geometric mean per capita hospitalization expenses was 25 885.61 yuan, and the total hospitalization expenses showed a downward trend over time(β=-4.281, P<0.001). From 2016 to 2020, the structural change rate of the hospitalization expenses for the fractured military wounded and sick in the hospital was 56.17%, and the average annual structural change rate was 18.68%. The top three individual expenses of the structural change rate were the expense of western medicine(24.03%), the expenses of medical materials(22.16%) and the expenses of diagnosis and treatment(19.46%), the cumulative contribution rate of the three was 65.65%. Multivariate regression analysis suggested that the influencing factors of the total hospitalization expenses of the fractured military wounded and sick in the military tertiary hospital included: admission year, discharge method, surgery, blood transfusion, western medicine treatment, Chinese traditional medicine treatment, age and length of hospitalization.Conclusion To rationally control the growth of the total hospitalization expenses of military wounded and sick, it is necessary to optimize the internal structure of hospitalization expenses, and control the length of hospitalization through selecting treatment plans.