中医优势病种脑梗死后遗症患者住院费用及影响因素分析

Analysis of Hospital Expenses and Influencing Factors of Cerebral Infarction Sequelae Patients with Dominant Diseases of TCM

目的:研究中医优势病种脑梗死后遗症患者住院费用的构成及其影响因素,为医院内部精细化管理和医保部门完善适合中医药特点的支付政策提供参考依据。方法:收集样本中医医院2020—2022年主要诊断ICD编码为I69.3的病例共1261例,通过运用单因素分析、相关性分析、多元线性逐步回归等方法,分析脑梗死后遗症期患者住院费用构成及主要影响因素。结果:脑梗死后遗症患者次均住院天数为16.71天,次均住院费用为24148.83元,次均中医治疗费占比为54.43%。逐步回归结果表明,住院天数、入院病情、合并肺部感染对住院费用均有显著影响(P<0.05),其中住院天数的影响最大。结论:建议医院优化完善中医优势病种临床路径和建立有效的动态管理机制,医保部门健全按病种分值付费下中医优势病种辅助目录调整机制。

Objective:To study the composition and influencing factors of hospitalization expenses of patients with sequelae of cerebral infarction caused by the dominant diseases of traditional Chinese medicine(TCM),so as to provide references for the fine management within the hospital and the medical insurance department to improve the payment policy suitable for the characteristics of TCM.Method:A total of 1261 cases with ICD code I69.3 in the sample of tertiary traditional Chinese medicine hospitals from 2020to 2022 were collected.Single factor analysis,correlation analysis,multiple linear stepwise regression and other methods were used to analyze the composition and main influencing factors of hospitalization expenses of patients with cerebral infarction sequelae.Results:The average length of hospital stay of patients with sequelae of cerebral infarction was 16.71 days per time,the average hospitalization cost was 24148.83 yuan per time,and the proportion of TCM treatment cost per time was 54.43%.The results of stepwise regression showed that the length of stay,the condition of admission and the complication of pulmonary infection had a significant impact on the hospitalization expenses(P<0.05),and the length of stay had the greatest impact.Conclusion:It is suggested that the hospital should optimize and improve the clinical pathway of TCM dominant diseases and establish an effective dynamic management mechanism,and the medical insurance department should improve the adjustment mechanism of the auxiliary list of TCM dominant diseases under the disease scoring payment.