新生儿高胆红素血症患儿住院费用的分位数回归分析

Quantile Regression Analysis of Hospitalization Costs in Neonates With Hyperbilirubinemia

目的 通过统计新生儿高胆红素血症患儿住院费用及相关母婴信息、住院信息、诊疗信息,分析单病种费用的影响因素,以期为医保按病种分值付费(diagnosis-intervention packet,DIP)方式改革和医院单病种费用控制提供可参考的建议和方法。方法 通过病案信息系统,调取2018—2022年在鲁中地区某三甲妇幼保健院住院治疗的新生儿高胆红素血症患儿的住院费用及相关信息,采用单因素分析、分位数回归分析患儿住院费用的影响因素。结果 年份、医疗付款方式、并发症、患儿年龄、住院天数、胎次、入院经皮测胆值、喂养方式、大便情况、总胆红素水平对患儿住院费用的影响差异有统计学意义(P<0.05)。不同分位费用组中,各影响因素作用方向及趋势不同。结论 我国公立医院实行的耗材“零差价”政策及药品集中带量采购,有效地遏制了患儿住院费用的增长;关爱母婴健康,降低血清总胆红素水平,减少无效的住院天数,降低新生儿高胆红素血症患儿并发症发生率是合理控制费用增长的重要手段。

Objective By analyzing the hospitalization expenses of neonates with hyperbilirubinemia and related maternal and child information,hospitalization information,and diagnosis and treatment information,to analyze the influencing factors of the single-disease cost,in order to provide reference suggestions and methods for the reform of diagnosis-intervention packet(DIP) payment method of medical insurance and the control of single-disease cost of hospitals.Methods Through the medical record information system,the hospitalization expenses and related information of neonatal hyperbilirubinemia children hospitalized in a Classⅲ Grade A maternal and child health hospital in central Shandong from 2018 to 2022 were collected.single factor analysis and quantile regression were used to analyze the influencing factors of hospitalization expenses of children.Results There were significant differences in the year,medical payment method,complications,age of children,length of hospital stay,parity,transcutaneous bilirubin value at admission,feeding mode,stool condition and total bilirubin level on hospitalization costs(P < 0.05).In different cost quantile groups,the direction and trend of each influencing factor were different.Conclusion The policy of "zero price margin" for consumables and centralized drug procurement in large quantities at public hospitals in China have effectively curled the growth of hospitalization costs of pediatric patients.Taking care of maternal and infant health,reducing serum total bilirubin level,reducing ineffective hospitalization days,and reducing the incidence of complications in neonates with hyperbilirubinemia are important means to control the increase of costs reasonably.