上海市某区老年慢性肾脏病患者住院总费用因子分析

Factor Analysis of Total Hospitalization Costs for Elderly Patients with Chronic Kidney Disease in a Certain District of Shanghai

目的分析老年患者住院总费用支出情况,找出影响成本的关键因素,为控制住院成本,减轻疾病经济负担提供可行性建议。方法以2015年1月1日至2022年12月31日上海市某区区级医疗机构的住院患者为研究对象。纳入主要诊断编码或次要诊断编码为“ICD-10=N18”的患者,排除年龄小于65岁的病例,期间住院人次数共计79274例。因子分析采用主成分法对初始因子进行提取,采取最大方差法对因子进行旋转从而找出新的共性因子。结果人均住院总费用从2015年的22208.9元下降至2022年的17089.21元,检查化验费和治疗费占比分别从2015年的21.82%和6.82%上升至2022年的27.05%和13.52%,药占比从2015年的48.91%降至2022年的30.6%;检验与西药因子、手术材料因子、治疗与护理因子、中药与诊疗因子、其它影响因子和输血因子是6个共性因子。结论药占比趋于合理,住院总费用控制的成效显著,现阶段进一步减轻住院成本的关键是控制治疗费和手术材料费的增长。

Objectives To analyze the total inpatient expenditure of elderly patients and find out the key factors affecting the costs,in order to provide feasible suggestions for controlling the inpatient costs and reducing the economic burden of disease.Methods The subjects were patients with chronic kidney disease in district-level medical institutions in a certain district of Shanghai from January 1st,2015 to December 31st,2022.Patients with primary or secondary diagnostic code of"ICD-10=N18"were included,cases under the age of 65 were excluded.During this period,there were a total of 79274 hospitalizations.In the factor analysis,the principal component method was used to extract the initial factors,and the maximum variance method was used to rotate the factors to find out the new common factors.Results The average total hospitalization costs decreased from 22208.9 yuan in 2015 to 17089.21 yuan in 2022.The proportion of examination and laboratory expenses and treatment costs increased from 21.82%and 6.82%in 2015 to 27.05%and 13.52%in 2022,respectively.The proportion of drugs decreased from 48.91%in 2015 to 30.6%in 2022;There were 6 common factors:test and western medicine factor,surgical material factor,treatment and nursing factor,Chinese medicine and diagnosis and treatment factor,other influence factor and blood transfusion factor.Conclusions The proportion of drugs tended to be reasonable and the total hospitalization costs control effect was remarkable,the key to further reduce the costs of hospitalization at this stage was to control the increase of the costs of treatment and surgical materials.