脑心共患疾病共治与分治模式的卫生经济学比较研究

A Comparative Study of Health Economics of Co-Management and Separate Management Models for Brain-Heart Comorbidity Diseases

目的评估脑心共患疾病在共治与分治两种模式下的卫生经济学效益,以确定更优的医疗策略,提高治疗效率与经济效益。方法本研究采用回顾性分析方法,收集2019年1月—2023年12月在首都医科大学附属北京天坛医院心血管内科、神经内科、神经外科、心血管外科和介入放射科等治疗的,符合中国疾病诊断相关分组(Chinese diagnosis related groups,CN-DRG)中神经系统疾病及功能障碍合并循环系统疾病及功能障碍患者的病历资料,记录患者的人口学特征、总住院天数、各类医疗费用以及病例组合指数(case mix index,CMI)和权重(relative weight,RW)。将患者分为共治组(一次住院期间对患者的脑心共患疾病进行统筹规划和综合治疗)与分治组(不同住院期间分别进行神经系统和心血管系统疾病的治疗),比较两组的基线特点及总住院天数、费用等经济学指标。结果共纳入442例患者数据。共治组总住院天数低于分治组(6 d vs.14 d,P<0.001)。经济学效益分析显示,共治组住院总费用低于分治组(65967元vs.106673元,P<0.001)。此外,共治组的RW高于分治组(2.24 vs.1.61,P<0.001)。结论相较于分治模式,共治模式下脑心共患疾病患者的住院时间更短,住院费用更低。共治模式有利于优化脑心共患疾病的医疗资源配置和诊疗流程。

Objective To evaluate the health economic benefits of the co-management and separate management models for patients with brain-heart comorbidity diseases,to determine better medical strategy,and to improve treatment efficiency and financial benefits.Methods This study used a retrospective analysis method to collect the medical records of patients who were clarified into both neurological disorders and dysfunction(code MDCB)and cardiovascular diseases(code MDCF)following the Chinese diagnosis related groups(CN-DRG)method,and received treatment at the department of cardiovascular,department of neurology,department of neurosurgery,department of cardiovascular surgery,and department of interventional radiology of Beijing Tiantan Hospital,Capital Medical University from January 2019 to December 2023.The data including demographic characteristics,total length of hospital stay,various medical expenses,case mix index(CMI),and relative weight(RW)were recorded.Patients were divided into two groups:a co-management group(comprehensive treatment of cerebrovascular and cardiovascular diseases during a single hospitalization)and a separate management group(treatment of neurological and cardiovascular diseases during separate hospitalizations).The baseline characteristics and economic indexes including the total length of hospital stay and medical expenses were compared between the two groups.Results A total of 442 patient data were included.The total length of hospital stay in the co-management group was significantly shorter than that in the separate management group(6 days vs.14 days,P<0.001).The economic benefit analysis showed that the total cost in the co-management group was significantly lower than that in the separate management group(¥65967 vs.¥106673,P<0.001).In addition,the RW value in the co-management group was significantly higher than that in the separate management group(2.24 vs.1.61,P<0.001).Conclusions Compared with the separate management model,the co-management model provides shorter hospital stays and lower total costs for patients with brain-heart comorbidity diseases,which is of great significance for optimizing the allocation of medical resources and the patient’s diagnosis and treatment process.