基于倾向性评分匹配及广义线性模型的出血性脑卒中医院感染经济负担研究

Study of economic burden of healthcare-associated infection caused by hemorrhagic stroke based on propensity score matching and generalized linear model

目的研究出血性脑卒中患者发生医院感染导致的经济负担。方法回顾性调查某三级甲等医院2021年1月1日—2022年12月31日的出血性脑卒中患者,收集其人口学特征、临床相关信息、住院费用等资料。根据是否发生医院感染将其分为医院感染组及对照组,采用倾向性评分匹配法和广义线性模型法研究医院感染组与对照组住院日数、住院费用增量及医院经济负担。结果共纳入688例患者,发生医院感染266例,医院感染发病率为38.66%。经过倾向性评分匹配,医院感染组199例患者成功匹配,医院感染组较对照组住院日数中位数增加16 d,增加1倍(Z=11.779,P<0.001),住院费用中位数增加34597.42元,增加85%(Z=6.299,P<0.001);广义线性模型法中归因于医院感染因素的住院日数增加1.24倍,住院费用增加76%(均P<0.001);单项医疗费用支出中,医院感染组除手术费用外,其他各项医疗支出均高于对照组(均P<0.05);因医院感染导致的医院经济负担为54.19万元。结论医院感染明显加重出血性脑卒中患者及医院的经济负担,延长住院时间,临床工作人员应加强感染防控意识,降低医院感染发病率,节约医疗资源。

Objective To study the economic burden caused by healthcare-associated infection(HAI)in patients with hemorrhagic stroke.Methods Patients with hemorrhagic stroke in a tertiary first-class hospital from January 1,2021 to December 31,2022 were surveyed retrospectively.Data on demographic characteristics,clinical information,and hospitalization expenses were collected.According to the occurrence of HAI,patients were divided into the HAI group and control group.The length of hospital stay,increase in hospitalization expense,and hospital economic burden of the HAI group and control group were studied by propensity score matching(PSM)method and generalized linear model method.Results A total of 688 patients were included in the study,with 266 cases experiencing HAI and a HAI incidence of 38.66%.After propensity score matching,199 patients in the HAI group were successfully matched.Compared with the control group,the median length of hospital stay in the HAI group doubled,increasing by 16 days(Z=11.779,P<0.001);the median hospitalization expense increased by 34597.42 Yuan,with an increase of 85%(Z=6.299,P<0.001).Based on the generalized linear model method,length of hospital days attributed to HAI increased by 1.24 times,hospitalization expense increased by 76%(both P<0.001).Except surgical expenses,the HAI group had higher single medical expenses than the control group(all P<0.05).Economic burden to hospital caused by HAI was 541900 Yuan.Conclusion HAI significantly increases the economic burden of hemorrhagic stroke patients and hospitals,and prolongs the length of hospital stay.Clinical staff should enhance the awareness on infection control,reduce the incidence of HAI,and save medical resources.