胃癌患者住院费用影响因素的通径分析

An analysis of the influencing factors of hospitalization expense of gastric cancer patients

目的探讨影响胃癌患者住院费用的主要因素。方法收集某肿瘤专科医院2009-2014年5年间7 386例胃癌患者的病案信息,采用逐步回归分析法以住院费用、住院天数为内生变量,拟合通径分析模型,筛选影响住院费用的直接效应和通过住院天数影响住院费用的间接效应。结果手术与否是影响住院费用的最主要因素;住院天数、转归情况、住院年份、伴随病、性别、年龄和职业直接影响住院费用;出院主诊断和医付方式间接影响住院费用;转归情况、手术与否、伴随病、住院年份等因素既可直接影响住院费用,又通过住院天数间接影响住院费用。手术与否、住院天数、转归情况影响住院费用总效应分别为0.604、0.585、-0.387。结论要降低住院费用,需要多部门共同努力,加强监督管理,合理治疗,合理用药,规范临床路径,优化治疗检查流程,完善多层次社会健康保障体系。

Objective To explore the potential influencing factors affecting hospitalization expenses of patients with gastric cancer. Methods A total of 7 386 valid medical records of patients with gastric cancer in a tumor hospital between 2009 and 2014 were studied. Stepwise regression was performed using the hospitalization expense and hospitalization days as the endogenous variables. The direct and indirect effects of the hospitalization expenses were screened by fitting the data with the path analysis model. Results Whether surgery is performed was the most influential factor which affects the hospitalization expense. Hospitalization days, outcomes, years, accompanying diseases, genders, ages and occupations directly affected the cost. The main diagnosis and medical payment influenced hospitalization expenses indirectly. Vesting conditions, surgery or not, co-morbidities, the year of hospitalization influenced the cost both directly and indirectly through influencing hospitalization days. The total effect of surgery or not,days of hospitalization, and the outcomes were 0.604, 0.585 and- 0.387, respectively. Conclusions To reduce the cost of hospitalization, the following approaches should be used: to make joint efforts of various departments, to strengthen supervision and management, reasonable treatment, rational use of drugs, the clinical path specification, optimization of treatment review process, to improve the healthcare security system.