摘要
目的:分析急性脑梗死患者住院费用的变化趋势及其影响因素，为医疗改革决策提供参考依据。方法:收集2012年1月至2017年12月在北京市某三甲医院神经内科住院的急性脑梗死患者的病历资料。分析住院费用的构成情况和变化趋势，采用多元线性回归分析影响住院费用的因素。结果:共纳入急性脑梗死住院患者2522例，2012年至2017年，人均住院费用由18 504.9元上升至24 569.6元；药费在住院总费用中的占比最大，2012年为63.4%，2017年为49.8%，人均药物费用2012年为11 724.6元，2017年为12 228.0元；化验费呈明显上升的趋势，其占比从2012年的9.5%上升至2017年的16.4%，实际人均费用从1749.8元上升至4019.9元；2017年人均检查费为2088.1元，占住院总费用的8.5%，较2012年增幅达24.5%；2017年人均综合医疗服务费为2785.8元，占住院总费用的11.3%，较2016年增幅达259.7%。影响急性脑梗死患者住院费用的因素包括住院时间、入院年份、使用抗菌药物、入院时美国国立卫生研究院卒中量表（NIHSS）评分、年龄、静脉溶栓治疗、伴发疾病数和主诊断出院情况。结论:急性脑梗死的住院费用呈现逐年上升的趋势；相关的化验、检查费用也呈现出明显的上升趋势；住院时间、抗菌药物使用、入院时NIHSS评分，以及静脉溶栓治疗是影响急性脑梗死患者住院费用的主要因素。
Abstract
Objective:To analyze the trend and influencing factors of hospitalization expenses in patients with acute cerebral infarction.Methods:The medical records of patients with acute cerebral infarction as the first diagnosis were collected, who were hospitalized in the department of neurology of a tertiary hospital in Beijing from January 2012 to December 2017. The composition and trend of hospitalization expenses were analyzed. The potential factors influencing hospitalization expenses were analyzed by multiple linear regression analysis.Results:A total of 2,522 inpatients with acute cerebral infarction were included. From 2012 to 2017, the hospitalization expenses per capita increased from 18,504.9 yuan to 24,569.6 yuan; the proportion of drug cost accounted for the largest part in the total hospitalization expenses, ranging from 63.4% in 2012 to 49.8% in 2017; the per capita drug cost was 11,724.6 yuan in 2012 and 12,228.0 yuan in 2017: laboratory cost showed an apparent upward trend, and its proportion increased from 9.5% in 2012 to 16.4% in 2017, and the actual per capita cost increased from 1,749.8 yuan to 4,019.9 yuan; the investigation cost in 2017 was 2088.1 yuan, accounting for 8.5% of the total hospitalization expenses, an increase of 24.5% compared to 2012; in 2017, the per capita comprehensive medical service fee was 2,785.8 yuan, accounting for 11.3% of the total hospitalization expenses, and an increase of 259.7% compared with 2016. The factors influencing the hospitalization expenses of patients with acute cerebral infarction were the length of stay, year of admission, use of antibiotics, National Institutes of Health stroke scale (NIHSS) score at admission, age, intravenous thrombolysis, number of concomitant diseases and discharge status.Conclusion:The hospitalization cost of acute cerebral infarction is increasing year by year; the related laboratory and examination costs also show an apparent upward trend; the length of stay, antimicrobial use, NIHSS score at admission, and intravenous thrombolytic therapy are the main factors affecting the hospitalization cost of patients with acute cerebral infarction.
基金项目
国家自然科学基金项目(81100522)
北京大学第三医院重点基金项目(Y78436-05)
万方数据