皮肤病专科医院高额住院费用影响因素的结构方程模型验证研究

Structural equation model validation study on the influencing factors of high hospitalization expenses in dermatology hospitals

目的 探究皮肤病专科医院高额住院费用的影响因素,为减轻患者医疗负担、优化医疗费用结构提供参考。方法 以2015—2019年广东省某大型三级甲等皮肤病专科医院高额住院费用患者的住院数据为例,运用差异性统计、结构方程模型分析高额住院费用的影响因素。结果 年龄(β=-0.072,P<0.001)、是否手术(β=0.157,P=0.001)、是否院感(β=0.043,P=0.030)、是否月内再入院(β=0.040,P=0.011)、是否使用抗菌药物(β=0.155,P<0.001)、住院天数(β=0.304,P<0.001)直接作用于住院费用,年龄(β=0.028,P<0.001)、婚姻状况(β=0.021,P<0.001)、是否合并症(β=0.026,P<0.001)、是否院感(β=0.017,P<0.001)、是否使用抗菌药物(β=0.089,P<0.001)、是否临床路径(β=0.001,P=0.001)通过作用于住院天数间接影响住院费用,且住院天数对皮肤病患者高额住院费用的影响最大(β=0.304,P<0.001)。结论 缩短住院天数、提高手术水平、合理使用抗菌药物、控制院内感染、减少合并症及月内再入院、完善临床路径管理是控制皮肤病专科医院高额住院费用的有效策略之一,同时还应加强对老年、已婚患者的监控。

Objective To analyze the influencing factors of high hospitalization expenses in a certain tertiary dermatology hospital,and to provide references for reducing the medical burden of patients and optimizing the structure of medical cost.Methods The hospitalization data of patients with high hospitalization costs from 2015 to 2019 in a large tertiary dermatology hospital in Guangdong Province were taken as an example,and variance statistics and structural equation modeling were used to analyze the influencing factors of high hospitalization costs.Results Age(β=-0.072,P<0.001),surgery(β=0.157,P=0.001),hospital infection(β=0.043,P=0.030),readmission within the month(β=0.040,P=0.011),use of antibiotics(β=0.155,P<0.001),and the length of hospital stay(β=0.304,P<0.001)directly affected hospitalization costs,while age(β=0.028,P<0.001),marital status(β=0.021),(P<0.001),comorbidity(β=0.026,P<0.001),hospital infection(β=0.017,P<0.001),use of antibiotics(β=0.089,P<0.001),and clinical pathway(β=0.001,P=0.001)indirectly affected the hospitalization cost by acting on the length of stay,and the length of stay had the greatest impact on the high hospitalization cost of patients with skin diseases(β=0.304,P<0.001).Conclusion Shortening the length of hospital stay,improving the level of surgery,rationally using antibiotics,controlling hospital infections,reducing comorbidities and readmission within the month,and improving clinical pathway management are one of the effective strategies to control the high hospitalization costs in dermatology hospitals.At the same time,the monitoring of elderly and married patients should be strengthened.