目的 探讨南充市脑梗死病人住院费用的组成，并对住院费用的影响因素进行分析。方法 在南充市中心医院及南充市嘉陵区人民医院的信息系统(Hospital Information System，HIS)中抽取出院时间在2018年1月—2022年1月的759例脑梗死患者相关资料，对比患者住院费用构成情况并对住院费用的影响因素进行多因素分析，构建预测住院费用增加的列线图模型并进行模型验证。结果 南充市2018-2021年间脑梗死患者住院费用占比最高的为药品费(46。11％)，其次为治疗费(24。31％)和检查费(18。34％);患者年龄(OR=8。671，95％CI:5。283～10。324)、住院年份(OR=1。941，95％CI:1。532～2。191)、参加医保(OR=3。939，95％CI:2。623～5。495)、入院情况(OR=4。654，95％CI:2。897～6。375)、住院天数(OR=4。256，95％CI:2。374～6。023)、是否手术(OR=3。482，95％CI:2。698～4。243)、是否卧床(OR=7。056，95％CI:3。659～8。953)、是否使用抗生素(OR=3。987，95％CI:1。659～5。253)、伴随疾病(OR=6。977，95％CI:4。267～8。153)和护理级别(OR=4。675，95％CI:2。563～6。398)是影响脑梗死患者住院费用的主要危险因素;列线图预测模型总分为602分，对应住院费用增加的概率为74。31％，具有良好的区分度、准确度和有效性。结论 参保情况以及住院天数较长等是使费用增加的主要因素，其中药品费和治疗费占比较高，因此在保证疗效的前提下，应适当缩短患者的住院天数，规范医保支付方式，减少过度用药和治疗，以此合理控制住院费用，控制医疗费用的不合理增长。
Analysis of Influencing Factors of Hospital Expenses for Cerebral Infarction Patients in Nanchong City
Objective To investigate the composition of hospitalization costs for patients with cerebral infarction in Nanchong City,and to analyze the influencing factors of hospitalization costs.Methods The data of 759 cerebral infarction patients who were discharged from January,2018 to January,2022 were selected.The composition of hos-pitalization expenses was compared and the influencing factors of hospitalization expenses were analyzed.A line graph model for predicting the increase of hospitalization expenses was constructed and verified.Results From 2018 to 2021,drug expenses(46.11％)accounted for the highest proportion of the hospitalization expenses of patients with diencephalic cerebral infarction in Nanchong city,followed by treatment expenses(24.31％)and examination expen-ses(18.34％).Patient age(OR=8.671,95％CI:5.283-10.324),year of hospitalization(OR=1.941,95％CI:1.532-2.191),participation in medical insurance(OR=3.939,95％CI:2.623-5.495),admission status(OR=4.654,95％CI:2.897-6.375),length of hospital stay(OR=4.256,95％CI:2.374-6.023),whether to have surgery(OR=3.482,95％CI:2.698-4.243),whether to stay in bed(OR=7.056,95％CI:3.659-8.953),whether antibiotics were used(OR=3.987,95％CI:1.659-5.253),concomitant disease(OR=6.977,95％CI:4.267-8.153),and level of care(OR=4.675,95％CI:2.563-6.398)were the most important risk factors affecting the hospitalization cost of cerebral infarc-tion patients.The total score of the line graph prediction model was 602,which corresponded to the probability of the increase of hospitalization expenses of 74.31％,with good differentiation,accuracy and effectiveness.Conclusion Insurance participation and long days in hospital are the main factors that increase the cost,among which the cost of drugs and treatment account for a relatively high proportion.Therefore,on the premise of ensuring the curative effect,we should appropriately shorten the length of stay,regulate the payment method of medical insurance,reduce excessive drug use and treatment,so as to control the reason-able hospitalization cost and control the unreasonable growth of medical cost.
万方数据
维普
