安徽省某公立医院冠心病人群特征及住院费用影响因素研究

Study on the characteristics of coronary heart disease population and factors influencing hospitalization costs in a public hospital in Anhui Province

目的:分析安徽省某三甲医院冠心病患者特征及其住院费用影响要素,以期为降低医疗成本、缓解病患经济压力提供依据。方法:收集安徽省某三甲医院2021-2022年冠心病患者的病案首页信息,通过描述性分析单因素分析、逐步回归分析、聚类分析和随机森林回归模型分析冠心病患者特征以及住院费用的影响因素。结果:共纳入14025例病例,冠心病患者住院总费用均值为26920.29元,耗材费占比最高(占37.98%),其次是药费(占23.55%)逐步回归结果显示,性别、职业类型、住院天数、住院次数对冠心病住院费用差异具有统计学意义(P<0.05)。随机森林回归模型分析得出各个影响因素的重要性排序为:住院天数(0.86)、职业类型(0.08)、住院次数(0.04)、性别(0.02)。结论:冠心病患者住院费用结构存在明显不合理性,主要体现在耗材费和药品费占比过高,显著增加患者经济负担。住院天数是关键因素,性别、职业类型和住院次数对费用也有显著影响。建议加强耗材和药品采购管理,优化医保政策,控制住院天数,并建立合理的医疗费用价值测算体系,以优化费用结构和减轻患者负担。

Objective:To analyze the characteristics of patients with coronary heart disease and the influencing factors of hospitalization costs in a third hospital in Anhui Province,in order to provide a basis for reducing medical costs and alleviating the economic pressure of patients.Methods:The homepage information of CHD medical records from a third-class A hospital in Anhui Province from 2021 to 2022 was collected,and the characteristics of CHD patients and the influencing factors of hospitalization costs were analyzed through descriptive analysis,univariate analysis,stepwise regression analysis,cluster analysis and random forest regression model.Results:A total of 14025 cases were included,and the average total hospitalization cost of patients with coronary heart disease was 26920.29 yuan,with the highest proportion of consumables cost(37.98%),followed by drug cost(23.55%).The stepwise regression showed that gender,occupation type,hospital days,and number of hospitalization numbers were statistically significant(P<0.05).Random forest regression model analysis ranked the importance of various influencing factors:Number of hospitalization(O.86),occupational type(0.08),number of hospitalization(0.04),gender(0.02).Conclusion:The sample hospital data suggest that there are many factors affecting the hospitalization cost of patients with coronary heart disease,and the cost structure is somewhat unreasonable.Number of hospitalization was the key factor,and gender,occupation type and number of hospitalizations also had significant effects on costs.so we should focus on shortening the number of hospitalization days and reducing the direct economic burden of patients.