2011-2015年某综合医院医院感染经济负担动态研究

发布时间：2018-03-18 04:36

本文选题：医院感染　切入点：直接经济负担　出处：《河北大学》2016年硕士论文　论文类型：学位论文

【摘要】：【研究目的】以保定市某综合医院为例,研究河北省中等城市2011-2015年医院感染经济负担动态变化特征,探寻其发展变化规律,以期为因地制宜地制定河北省中等城市医院感染经济负担控制措施提供依据。【研究方法】采用1:1配比病例对照研究方法,以保定市某综合医院2011年1月~2015年12月间入院并发生医院感染的病例作为病例组;按入院时间相近、住院科室和首要诊断相同等条件将未发生医院感染的、同时期入院患者进行1:1匹配作为对照组进行研究。通过从该综合医院的医院感染实时监控系统、病案室及计算机中心,回顾性收集病例组和对照组的一般资料与各种医疗费用,计算医院感染的直接经济负担;依据住院天数分析医院感染导致的患者本人及陪护家属因误工造成的经济损失来计算间接经济负担。利用绝对增长量、发展速度、增长速度等指标对5年内经济负担(直接与间接经济负担)动态变化特征进行分析。【研究结果】1、医院感染的现患率:2011年1月~2015年12月间,该综合医院共收治住院病例257369人,其中3745人发生医院感染,平均现患率为1.46%。5年医院感染现患率分别为1.57%、1.56%、2.21%、1.27%和0.84%。2、总体和平均直接经济负担分析:按照1:1匹配条件,2993例匹配成功而进入统计分析,其中男性1683例占56.23%,女性1310例43.77%。2011-2015年5年间2993例医院感染病例总住院花费为142,019,333.82元,其中因医院感染而造成的直接经济负担为69,101,048.86元,占总住院花费的48.66%。2011-2015年5年的年度医院感染直接经济负担分别为12,067,846.95元、13,029,734.64元、21,264,377.68元、16,480,574.02元和6,258,875.57元;人均直接经济负担分别为14887.92元、18511.76元、16230.29元、15382.33元和8370.40元。5年平均发展速度为86.59%,平均增长速度为-13.41%。5年间人均直接经济负担总体下降6517.52元,下降了43.77%。3、不同费用项目直接经济负担分析:2011-2015年医院感染直接经济负担为69,101,048.86元,其中西药费31,136,522.49元占45.06%,诊疗费18,148,143.79元占26.26%,护理费4,666,220占6.75%,化验费4,467,061占6.46%。可见西药支出所增加的经济负担最多、其次为诊疗、化验和护理支出。从2011-2015年动态分析结果来看,西药费2013年开始有明显下降,与2011年比下降4101.35元,下降了32.49%;而诊疗、化验和护理支出在2013年均出现上升现象,2015年方开始下降。4、不同科室直接经济负担分析:2011-2015年医院感染直接经济负担为69,101,048.86元,其中神经外科17,743,529.89元占25.68%,神经内科11,436,217.90元占16.55%,重症医学科5,264,595.00元占7.62%,血液内科3,383,121.21元占5.55%,中西医结合科2,626,754.04元占3.80%,骨科1,867,581.60元占2.70%。从5年人均直接经济负担来看,神经外科、神经内科、重症医学科、血液内科等为历年负担较重科室,因此控制医院感染经济负担应将上述科室列为重点科室。5、医院感染间接经济负担分析:2011-2015年因延长人均住院天数分别为10天、9天、8天、8天和4天,按照当年人均工资水平计算的间接经济负担(患者本人和1名陪护家属误工费用)分别为1684.40元、1677.96元、1675.98元、1829.44元和1006.44元。动态分析表明,2014年有小幅上升,2015年很快回落,5年间共下降680.24元,下降了40.34%。【研究结论】1、近5年该综合医院医院感染平均现患率为1.46%,低于全国一般水平,但医院感染的管理与控制仍任重而道远。2、2011-2015年间医院感染直接经济负担占总住院费用的48.66%。医院感染大幅增加医疗费用,给患者带来沉重经济负担,浪费卫生资源。利用医院感染实时监控系统及时预警疑似病例,是控制医院感染直接经济负担的重要方法。3、从费用项目上分析,西药费、诊疗费、化验费和护理费是医院感染直接经济负担的重要构成部分,是控制的重点费用项目。4、从科室部门来看,神经外科、神经内科、重症医学科、血液内科等科室长期居于前列,是控制和减少医院感染直接经济负担的重点科室部门。5、对医院感染疑似病例及时预警,并根据药敏试验结果规范使用抗生素等治疗措施,是缩短住院天数,降低间接经济负担的重要途径。
[Abstract]:[Objective] to a general hospital in Baoding city as an example, the dynamic characteristics of the economic burden of infection in Hebei province secondary city 2011-2015 years of hospital, to explore the law of development, in order to provide the basis for control measures according to local conditions to develop the economic burden of hospital infection in medium-sized city in Hebei province. [Methods] using 1:1 matched case-control study was conducted in Baoding City, a comprehensive hospital in January 2011 ~2015 December admitted to hospital and hospital infection cases as the case group; according to the admission time is similar to that of hospital and primary diagnosis of the same condition without nosocomial infection during the same period, patients were matched 1:1 as control group were studied. The infection from the comprehensive real-time monitoring system hospital, medical and computer center, were retrospectively collected from the patients and the control group of general information and medical expenses, calculation The direct economic burden of hospital infection; on the basis of analysis to calculate the indirect economic burden of hospital infection caused the patients themselves and their family members due to loss of economic losses caused by the number of days of hospitalization. The absolute increase in the amount, the speed of development, the growth rate as index of 5 years economic burden (direct and indirect economic burden) dynamic characteristics were analyzed. [results] 1, the prevalence rate of nosocomial infection: January 2011 ~2015 year in December, the hospital general hospital were treated in 257369 cases, of which 3745 people hospital infection, the average prevalence rate of prevalence rate of nosocomial infection was 1.57%, 1.46%.5 1.56%, 2.21%, 1.27% and 0.84%.2, and the average overall analysis the direct economic burden of 1:1: according to the matching condition, 2993 cases, and successfully entered into statistical analysis, including 1683 male cases accounted for 56.23%, 1310 women with 43.77%.2011-2015 and 5 years in 2993 cases of nosocomial infection cases in total Hospital cost is 142019333.82 yuan, the direct economic burden due to hospital infection caused by 69101048.86 yuan, accounting for the total hospitalization expenses of 48.66%.2011-2015 over the past 5 years the annual direct economic burden of hospital infection were 12067846.95 yuan, 13029734.64 yuan, 21264377.68 yuan, 16480574.02 yuan and 6258875.57 yuan per capita; the direct economic burden was 14887.92 yuan, 18511.76 yuan 16230.29 yuan, 15382.33 yuan and 8370.40 yuan, the speed of.5 average annual growth of 86.59%, the average growth rate for -13.41%.5 years, the direct economic burden per capita decreased 6517.52 yuan, down 43.77%.3, analysis of the direct economic burden of different project cost: 2011-2015 years of hospital infection direct economic burden of 69101048.86 yuan, of which 31136522.49 Yuan medicine costs accounted for 45.06%. Fee 18148143.79 yuan accounted for 26.26%, 4666220 nursing fees accounted for 6.75%, accounting for 4467061 of the 6.46%. visible test fees Increase the economic burden of most western medicine expenditure, followed by treatment, testing and nursing expenses. 2011-2015 years from the dynamic analysis results, the cost of Western medicine began in 2013 has decreased significantly, compared with 2011 down 4101.35 yuan, down 32.49%; while the treatment, testing and nursing expenses in the 2013 annual rise, 2015 began to decrease.4 analysis, the direct economic burden of different departments: 2011-2015 years of hospital infection direct economic burden of 69101048.86 yuan, of which 17743529.89 yuan accounted for 25.68% of the Department of Neurosurgery, Department of Neurology, 11436217.90 yuan accounted for 16.55%, severe medicine 5264595 yuan accounted for 7.62%, blood medicine 3383121.21 yuan accounted for 5.55%, 2626754.04 yuan accounted for 3.80%, combining Chinese and Western medicine, Department of orthopedics 1867581.60 yuan accounted for 2.70%. from 5 the annual per capita direct economic burden, Department of Neurosurgery, Department of Neurology, ICU, hematology, etc. in recent years due to the heavy burden of departments. This should be the Department as a key department.5 economic burden of hospital infection, hospital infection: analysis of indirect economic burden due to the extension of 2011-2015 years per capita hospitalization days were 10 days, 9 days, 8 days, 8 days and 4 days, indirect economic burden calculation according to the average wage level (I patients and 1 caregivers the family lost fees) were 1684.40 yuan, 1677.96 yuan, 1675.98 yuan, 1829.44 yuan and 1006.44 yuan. The dynamic analysis showed that there was a small rise in 2014, 2015 fall soon, a total of 5 years fell 680.24 yuan, down 40.34%. [conclusions] 1, nearly 5 years the average hospital general hospital infection prevalence rate 1.46%, lower than the national average level, but the management and control of hospital infection still go15 hospital infection during.22011-2015 the direct economic burden of the total hospitalization expenses of 48.66%. hospital infection greatly increased medical costs, patients brought by heavy Economic burden, waste of health resources. The hospital infection monitoring system timely warning of suspected cases, is an important method of controlling hospital infection in the direct economic burden of.3, analysis, medicine charge, fee from fees, testing fees and nursing is an important part of the direct economic burden of hospital infection, is the focus of project cost control.4, from the Department of department, Department of Neurosurgery, Department of Neurology, ICU, hematology department is in the forefront of long-term, hospital infection control and reduce the direct economic burden of key departments Department of.5, hospital infection of suspected cases timely warning, and according to the results of drug sensitive test to regulate the use of antibiotics and other treatment measures is to shorten the hospitalization number of days, an important way to reduce the indirect economic burden.

【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.32

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