基于R软件的脑出血患者住院费用分析

发布时间：2018-05-30 03:38

本文选题：脑出血 + 医疗保险　；参考：《天津医科大学》2013年硕士论文

【摘要】：目的：通过对天津市2003～2007年参加城镇职工基本医疗保险的脑出血患者住院费用资料的描述,了解天津市参保脑出血患者的一般人口学特征、了解其住院费用分布及明细构成；通过对资料的分析,找出影响住院费用的主要因素；通过对数据的深入挖掘,发现导致住院费用超限的潜在原因。为合理控制脑出血患者住院费用,降低患者家庭经济负担提供参考依据。方法：在天津市2003～2007年参加城镇职工基本医疗保险的患者资料库中抽取脑出血患者记录总数的15%,共计3119例,剔除住院天数与住院次数为“0”或缺失的观测,剩余有效例数2895例。运用SPSS13.0对患者个人情况及各住院费用明细进行一般统计描述。对参保患者的住院费用及其影响因素进行多元线性回归分析,采用数据挖掘关联规则分析中的Apriori算法对导致患者住院费用超限的因素进行探索,运用R(2.14.2)软件对患者住院费用情况进行多元线性回归分析以及关联规则分析。结果：(1)天津市2003～2007年参加城镇职工基本医疗保险的脑出血患者住院人均总费用中位数为10913.17元。住院费用中药品费、治疗费、检查费所占比例最大,分别占47.7%、25.3%、10.3%,三者共计83.3%,占患者住院费用的主要部分。5个年度的费用呈逐年上升趋势,2005年略有回落。参保患者中男性患者占68.5%,女性患者占31.5%；参保患者年龄平均(63.46±11.98)岁,其中青年组占4.9%、中年组占34.7%、老年组占60.4%；参保患者住院1次的占82.2%,2次及以上的占17.8%;参保患者住院天数中位数19天,平均(22.77±18.01)天；参保患者做手术的占29.3%,未做手术的占70.7%；参保患者在一级医院住院的占0.9%,在二级医院住院的占21.3%,在三级医院住院的占77.8%；参保患者的参保区县中,在市内六区的占73.7%,在滨海新区的占5.1%,在环城四区的占14.7%,在两区三县的占6.5%。(2)单因素分析结果显示：不同性别、不同年龄组、不同住院次数分组之间患者住院费用差异无统计学意义(P0.05)；进行手术治疗患者的住院费用高于非手术患者(P0.05)；三级医院患者住院费用高于一级医院和二级医院(P0.05)；市内六区和环城四区的参保患者住院费用较滨海新区和两区三县的患者高(P0.05)。(3)多元线性回归分析结果显示：性别和参保区县因素对住院费用影响无统计学意义(P0.05)；患者住院费用随患者年龄增大而增长；患者住院费用随患者住院次数增加而减少；患者住院费用随患者住院医院的级别增高而增长。各个影响因素中：对住院费用的增长影响最大的因素为患者的住院天数；其次为患者进行手术；然后为患者住院的医院类别,三级医院对住院费用的影响较一、二级医院大。(4)关联规则分析结果显示：手术因素与住院天数因素是导致脑出血患者住院费用超限最主要的因素,性别、医院类别、住院次数等因素也是患者住院费用超限的相关因素。结论：通过对天津市参保脑出血患者住院费用的一般描述、多元线性回归分析以及关联规则分析,得到了影响住院费用的主要因素。对于患者来说,控制住院费用的途径主要包括：(1)在病情不加重的前提下,无需做手术治疗的患者尽量采取保守治疗,必须做手术的患者应尽早采取手术治疗；(2)合理控制患者住院天数,减少不必要的住院时间,控制住院期间产生的检查、材料、床位等费用；(3)可以在二级医院就诊的患者尽量减少去三级医院住院治疗次数；(4)对于已发病的患者应及早控制住病情,对患病风险高的患者应积极采取预防措施,将脑出血的发病控制在最低限度。对于卫生决策部门来说,合理规划配置卫生资源、建立健全医疗保险政策制度是提高人民生活质量、构建和谐社会的重要保证。
[Abstract]:Objective: to understand the general demographic characteristics of the patients with cerebral hemorrhage in Tianjin, and to find out the distribution and composition of the hospitalization expenses, through the analysis of the data, and to find out the main factors affecting the hospitalization expenses through the description of the data of the hospitalization expenses of the patients with cerebral hemorrhage in Tianjin for 2003~2007 years. Through the thorough excavation of the data, the potential causes of excessive hospitalization costs are found, which provide a reference for the rational control of the hospitalization expenses of the patients with cerebral hemorrhage and the reduction of the family economic burden of the patients.
Methods: a total of 15% of the total number of cerebral hemorrhage patients were extracted from the database of patients who participated in the basic medical insurance of urban workers in Tianjin for 2003~2007 years. A total of 3119 cases were taken out of the number of hospitalization days and hospitalization times "0" or missing. The number of remaining effective cases was 2895 cases. The patients' personal situation and the cost of hospitalization were carried out by SPSS13.0. General statistical description. Multivariate linear regression analysis was carried out on the hospitalization expenses of the insured patients and their influencing factors. The Apriori algorithm in data mining association rules was used to explore the factors that resulted in patients' hospitalization expenses, and the R (2.14.2) software was used to carry out multiple linear regression analysis and correlation of patients' hospitalization expenses. Rule analysis.
Results: (1) the median per capita total cost of cerebral hemorrhage patients who participated in basic medical insurance for urban workers in Tianjin for 2003~2007 years was 10913.17 yuan per capita. The proportion of hospitalized cost of Chinese medicine, treatment and inspection was the largest, accounting for 47.7%, 25.3%, 10.3%, three of 83.3%, accounting for the main part of the patient's hospitalization expenses for.5 years. There was a year of rising trend year by year, a slight decline in 2005. Male patients accounted for 68.5% of the insured patients, women accounted for 31.5%, the average age of the insured patients (63.46 + 11.98) years, including 4.9% in the youth group, 34.7% in the middle age group, 60.4% in the elderly group, 82.2% in the 1 hospitalized patients and 17.8% in 2 and above, and 68.5% in the median of hospitalized patients. Day, the average (22.77 + 18.01) days, 29.3% of the insured patients, 70.7% without operation, 0.9% in the first level hospital, 21.3% in the two hospital, 77.8% in the three level hospital, 73.7% in the six District of the insured patients, 5.1% in Binhai New Area, and four in the Binhai New Area, four around the city. The area accounted for 14.7%, and the single factor analysis of 6.5%. (2) in three counties in two districts showed that there was no significant difference in the cost of hospitalization between the different sex, the different age groups and the different times of hospitalization (P0.05); the hospitalization expenses of the patients undergoing surgical treatment were higher than those of the non operative patients (P0.05); the hospitalization expenses of the three level hospitals were higher than the first level. The hospital and two level hospital (P0.05); the hospitalization expenses of the insured patients in the six and the four districts of the city were higher than those in the Binhai New Area and the three counties in the two district (3). (3) multivariate linear regression analysis showed that there was no statistical significance (P0.05) for the influence of the gender and the insured area and county factors on the hospitalization expenses (P0.05); the hospitalization expenses of the patients increased with the age of the patients. The hospitalization costs of patients were decreased with the number of hospitalized patients; the hospitalization costs of patients increased with the level of hospitalized hospitals. The effect of hospital on hospitalization costs is more than one, two level hospitals are large. (4) the results of association rules analysis show that the factors of operation factors and hospital days are the most important factors leading to the overlimit of hospitalization expenses in the patients with cerebral hemorrhage, and the factors such as sex, hospital category, and hospitalization are also related factors.
Conclusion: through the general description of the hospitalization expenses of the patients with cerebral hemorrhage in Tianjin, the multiple linear regression analysis and the analysis of the association rules, the main factors that affect the hospitalization cost are obtained.
For the patients, the main ways to control the hospitalization cost include: (1) in the condition that the condition is not aggravated, the patients who do not need to do the operation treatment should take the conservative treatment as far as possible. The patients who must do the operation should take the surgical treatment as soon as possible; (2) the reasonable control of the patient's hospital days, the reduction of the unnecessary hospitalization time, and the control of the inspection during the hospitalization. Check, material, bed and other expenses; (3) the patients who can be hospitalized in the two level hospital should try to reduce the number of hospitalization to the three level hospitals as far as possible; (4) for the patients who have been ill, the patients with high risk should take precautionary measures to control the incidence of cerebral hemorrhage to the minimum.
For the health decision-making department, the rational planning and allocation of health resources and the establishment and improvement of the medical insurance policy system are the important guarantee for improving the people's quality of life and building a harmonious society.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3;R743.34;F842.684

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