摘要
目的 探究慢性阻塞性肺疾病(简称慢阻肺)患者住院费用的影响因素,为减轻患者负担、制定相应医疗卫生政策提供依据.方法 选取2019-2022年北京市某三级综合医院慢阻肺住院患者的病案首页信息,通过描述性分析、秩和检验、相关分析及多因素回归分析,对患者住院费用及其影响因素进行探究.结果 1 053例慢阻肺患者中男性(66.0％)多于女性(34.0％),60～89岁患者占比最高(82.8％),医保付费患者最多(88.2％),急诊入院患者(57.1％)高于门诊入院患者(42.9％),实际住院天数10～19 d的患者占比最高(45.3％).慢阻肺患者高发季节为秋冬季(51.9％),常见合并症为冠心病(78.3％)、高血压(73.0％)、肺源性心脏病(48.5％).住院费用中居前3位的依次为西药类(36.75％)、医疗服务类(29.57％)、诊断类(22.82％).不同年龄、医疗付费方式、住院天数,是否合并高血压、冠心病、呼吸衰竭、肺源性心脏病,是否使用抗菌药物治疗、呼吸机辅助治疗等患者间住院费用存在差异且差异有统计学意义(P＜0.05).回归分析表明年龄越大、住院天数越长、合并症数量越多、使用抗菌药物和呼吸机治疗,住院费用越高;相对于医保患者,公费医疗方式与住院费用呈正相关(P＜0.05).结论 应加强健康宣教,对老年患者、有心血管疾病史的慢阻肺患者早期筛查和干预,利用多学科诊疗模式和完善临床路径规范诊疗流程、合理缩短住院日,减少医疗资源浪费、减轻患者经济负担.
Abstract
Objective To investigate the factors affecting hospitalization costs of hospitalized patients with chronic ob-structive pulmonary disease(COPD),so as to reduce the burden of patients,promote the rational allocation of medical re-sources,and provide a basis for formulating healthcare policies.Methods The medical record homepage data of chronic obstruc-tive pulmonary hospitalized patients in a tertiary general hospital in Beijing from 2019 to 2022 were selected to study the influen-cing factors of the hospitalization costs through descriptive analysis,rank sum test,correlation analysis,and multifactor regression analysis.Results Male patients(66.0％)outnumbered female patients(34.0％)among 1 053 COPD patients,the proportion of patients aged 60-89 years old was the highest(82.8％),the number of medicare-paid patients was the highest(88.2％),emergency admissions(57.1％)were higher than outpatient admissions(42.9％),and the percentage of hospitalization days with 10-19 days was the the most(45.3％).The high incidence seasons of chronic obstructive pulmonary disease were fall and winter(51.9％),and common comorbidities were coronary heart disease(78.3％),hypertension(73.0％),and pulmonary heart disease(48.5％).Chinese and Western medicine(36.75％),medical services(29.57％),and diagnosis(22.82％)accounted for the largest share of hospitalization costs.There was a statistical difference in hospitalization costs for variables of age,medical payment method,number of hospitalization days,comorbidities of hypertension,coronary heart disease,respiratory failure,pulmonary heart disease,treatment with antimicrobials,and ventilator-assisted therapy(P＜0.05).Regression analysis showed that the older the age,the longer the hospitalization days,the higher the number of comorbidities,the more use of antimi-crobial drugs and ventilator therapy,the higher the hospitalization costs.Compared to medical insurance patients,public medical care was positively correlated with hospitalization costs(P＜0.05).Conclusion Health education should be strengthened,early screening and intervention for elderly patients and COPD patients with a history of cardiovascular disease should be carried out,and multidisciplinary diagnostic and treatment modes and improved clinical pathways should be utilized to standardize the diagnos-tic and treatment processes,logically shorten the average number of hospitalization days,reduce the waste of medical resources and alleviate the patients'economic burden.
万方数据