三甲综合医院三类单病种住院费用构成研究

Study on the Composition of Hospitalization Expenses for Three Types of Single Diseases in Three A and Tertiary General Hospitals

目的分析某院3类单病种住院费用结构及影响因素,为医院开展单病种住院费用管理提供依据。方法收集某院2019年1月1日-2019年12月31日住院病案首页信息及费用明细,选取3个单病种,以主要诊断检索出直肠癌287例、结节性甲状腺肿227例、慢性肾衰竭(血液透析)710例,以住院总费用为因变量,以支付方式、转归情况、有无其他诊断为自变量进行多元线性回归分析。结果结节性甲状腺肿患者手术费用占51.17%,慢性肾衰竭(血液透析)患者检查费用占29.79%、药费28%。logistc回归分析表明,支付方式、转归情况、有无其他诊断是直肠癌患者(F=21.400,P<0.001.R^(2)=0.678)、结节甲状腺肿患者(F=19.210,P<0.001.R^(2)=0.771)、血液透析的慢性肾衰竭患者(F=28.105,P<0.001.R^(2)=0.612)住院费用的主要影响因素,回归方程拟合优度较好。结论影响单病种费用的综合因素有:支付方式、转归情况、有无次诊断等,适当降低检查费、缩短平均住院日、合理用药能有效控制住院费用。

Objectives To analyze the structure and influencing factors of hospitalization expenses of three types of single disease in a hospital,and to provide a basis for the hospital to carry out the management of hospitalization expenses of single disease.Methods From January 1st,2019 to December 31st,2019,the front page information and cost details of inpatient medical records in a hospital were collected.Three single diseases were selected and 287 cases of rectal cancer,227 cases of nodular goiter and 710 cases of chronic renal failure(hemodialysis)were retrieved based on the main diagnosis.Multiple linear regression analysis was performed with payment method,outcome and other diagnoses as independent variables.Results The cost of operation in patients with nodular goiter accounted for 51.17%,the cost of examination in patients with chronic renal failure(hemodialysis)accounted for 29.79%,and the cost of medicine accounted for 28%.logistic regression analysis showed that payment method,outcome,and other diagnosis were rectal cancer patients(F=21.400,P<0.001.R^(2)=0.678),nodular goiter patients(F=19.210,P<0.001),P<0.001.R^(2)=0.771)and hemodialysis patients with chronic renal failure(F=28.105,P<0.001.R^(2)=0.612)were the main influencing factors of hospitalization costs,and the regression equation had a good goodness of fit.Conclusions The comprehensive factors that affected the cost of single disease include payment method,outcome,whether there was a second diagnosis,etc.Appropriately reducing the examination cost,shortening the average length of stay,and rational drug use could effectively control the cost of hospitalization.