基于CHS-DRG评估异基因造血干细胞移植患者医院感染经济负担
Assessment of economic burden of allogeneic hematopoietic stem cell transplantation patients due to nosocomial infection based on CHS-DRG
曹煜隆 1单娇 2吕萌 3刘立煌 4王晓荣 5龚志忠 6金梦 7包小源7
作者信息
- 1. 北京大学人民医院感染管理-疾病预防控制处,北京 100044
- 2. 北京积水潭医院院感处,北京 100035
- 3. 北京大学人民医院血液科,北京大学血液病研究所,国家血液系统疾病临床医学研究中心,造血干细胞移植治疗血液病北京市重点实验室,北京 100044
- 4. 北京大学人民医院病案统计室,北京 100044
- 5. 北京恒和通达信息技术有限公司,北京 100176
- 6. 首都医科大学附属北京中医医院医务处,北京 100010
- 7. 北京大学医学信息学中心,北京 100191
- 折叠
摘要
目的 基于国家医疗保障疾病诊断相关分组(CHS-DRG)评估异基因造血干细胞移植(allo-HSCT)患者医院感染所致直接经济负担.方法 回顾分析2014-2018年8家医疗机构病案首页数据,按DRG分组后,比较组间发生医院感染与未发生医院感染患者住院日和住院费用,分析医院感染直接经济负担.结果 共有allo-HSCT 患者3 831例,其中伴严重并发症或合并症组(AG11)2 322例,医院感染发生率为18.91％,中位住院天数为60(40,82)d,中位住院费用为29.26(19.63,39.76)万元;不伴严重并发症或合并症组(AG15)1 509例,医院感染发生率为13.52％,中位住院天数为39(31,50)d,中位住院费用为21.67(15.84,27.77)万元.医院感染组住院费用和住院日均高于非医院感染组,住院费用中位数差值为10.63万元,住院日中位数差值为15d.结论 allo-HSCT 术后医院感染发生率高,给患者和医院都带来较大的经济负担.在DRG背景下,allo-HSCT作为高风险高难度的治疗,极易超过支付费用造成医院亏损,为了提高医院收治疑难重症病例的积极性,切实保护患者的利益,应建立更完善的补偿机制和更精准的分组方式.
Abstract
OBJECTIVE To evaluate the direct economic burden of the allogeneic hematopoietic stem cell transplan-tation(allo-HSCT)patients due to nosocomial infection based on CHS-Diagnosis Related Groups(CHS-DRG).METHODS The data on the first page of medical records were collected from 8 healthcare institutions from 2014 to 2018 and were retrospectively analyzed and were grouped based on DRG.The length of hospital stay and hospitali-zation cost were compared between the patients with nosocomial infection and the patients without nosocomial in-fection.The direct economic burden due to the nosocomial infection was observed.RESULTS Among 3 831 allo-HSCT patients,2 322 were complicated with severe complications or AG11,the incidence of nosocomial infection was 18.91％,the median length of hospital stay was 60(40,82)days,the median hospitalization cost was 292 600(196 300,397 600)yuan.Totally 1 509 patients were not complicated with severe complications or AG15,the in-cidence of nosocomial infection was 13.52％,the median length of hospital stay was 39(31,50)days,the median hospitalization cost was 216 700(158 400,277 700)yuan.The hospitalization cost of the nosocomial infection group was more than that of the non-nosocomial infection group,the length of hospital stay of the nosocomial in-fection group was longer than that of the non-nosocomial infection group,the median difference value of the hospi-talization cost was 106 300 yuan,and the median difference value of the length of hospital stay was 15 days.CONCLUSION The incidence of postoperative nosocomial infection is high among the allo-HSCT patients,which brings heavy economic burden to both the patients and hospitals.As a high-risk and highly difficult treatment un-der the background of DRG,allo-HSCT is more likely to exceed the cost and leads to the loss of the hospital.It is necessary to establish a more thorough compensation mechanism and more precise grouping method so as to boost the enthusiasm for treatment of suspected and severe cases and benefit the patients.
关键词
异基因造血干细胞移植/疾病诊断相关分组/医院感染/经济负担/住院日数/住院费用/国家医疗保障疾病诊断相关分组Key words
Allogeneic hematopoietic stem cell transplantation/Diagnosis related groups/Nosocomial infection/Economic burden/Length of hospital stay/Hospitalization cost/China healthcare security diagnosis related groups引用本文复制引用
基金项目
国家卫生健康委医院管理研究所"感动中国"医疗机构感染预防与控制科研基金资助项目(GY2023044)
北京大学人民医院研究与发展基金资助项目(RDM2023-05)
出版年
2024
NETL
NSTL
万方数据