基于递归系统模型的某三甲医院住院费用分析和影响因素研究

发布时间：2018-05-04 18:51

本文选题：住院费用 + 递归系统模型　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:三级甲等综合医院是我国最重要的医疗服务供给侧,很大程度上决定我国医疗服务质量和医疗卫生经济走向,也是我国制定卫生政策的重要信息来源。供给侧改革是我国政府积极推动的重要改革策略。对三级甲等综合医院的住院费用进行深入的信息挖掘(information minning)不仅可以科学掌握住院费用的整体构成和影响因素,完善综合医院的管理能力,提高医疗服务质量,同时也是我国制定公立医院改革策略的重要参考依据。本文的研究目的是通过对大型三级甲等医院的住院费用进行信息挖掘,探索递归系统模型在大型综合医院住院费用分析中的价值,了解大型综合医院住院费用的影响因素,为有效利用卫生资源,减轻社会和患者的经济负担,制定合理卫生政策提供依据。方法:本研究采用定点定时的方法收集广西某三级甲等综合医院所有住院病例病案。剔除资料信息不全的患者,将所有合格病案首页信息和住院信息导入Excel 2016,建立病案数据库,在对数据进行描述性研究的基础上,采用单因素分析、递归系统模型结合路径图对总住院费用、大额住院费用、主要病种费用进行分析。探讨大型综合医院住院费用的主要构成和重要影响因素。递归系统模型和路径图分析分别由SPSS 18.0软件和Amos22.0软件来完成。结果:结果显示本研究的大型综合三甲医院的患者平均住院天数为8天(中位数),平均住院费用为6245.01元(中位数)。平均中位年龄50.92岁,60岁以上人数最多,占35.28%。女性患者住院构成52.42%,高于男性的47.58%,人均住院费用男性高于女性。1万元以下费用者占73.14%,5万元以上的大额住院费用病例占2.70%;住院费用构成由高到低依次为药费(38.29%)、材料费(15.1%)、治疗费(14.06%)、化验费(12.64%)、手术费(7.13%)、检查费(6.58%)、其他费用(5.3%)、护理费(0.90%)。费用构成前四位占全院总住院费用的80.09%。住院疾病构成以肿瘤最多,占20.03%。其次是循环系统疾病,第三位是消化系统疾病。病种平均住院费用排前三位依次是:肿瘤(9335.88元),损伤和中毒(8221.25元)、循环系统疾病(7791.07元)。根据统计结果,住院时间长短是平均住院费用高低的首位影响因素。按总效应排序,对住院费用影响较大的因素有住院天数、是否手术、是否抢救、年龄、肿瘤。对大额住院费用影响总效应较大的是住院天数、是否抢救、呼吸系统疾病、是否手术等。结论:三甲综合医院住院费用构成仍以药费占比最高,医务人员技术服务价值偏低。肿瘤、循环系统疾病等慢性非传染性疾病占比大,平均住院费用高。大额住院费用比例小,花费大,材料费上升明显。住院天数对住院费用影响效应最大,缩短平均住院日是控制费用增长的关键。手术、抢救、高年龄、肿瘤患者住院费用相对较高。研究结果发现递归系统模型在筛检住院费用主要影响因素方面能较好体现影响因素的层次结构,较多因素回归分析具有一定的优越性,能够帮助我们更为全面的挖掘出住院费用的直接和间接影响因素,从而采取更有利的费用控制措施和办法。
[Abstract]:Objective: the three grade a general hospital is the most important supply side of medical service in China, to a great extent, it determines the quality of medical service and the trend of medical and health economy in our country. It is also an important source of information for our country to formulate health policy. The supply side reform is the important reform strategy of our government actively promoting the hospitalization of the three grade a general hospital. The in-depth information mining (information minning) not only can grasp the overall composition and influencing factors of the hospitalization expenses, improve the management ability of the comprehensive hospital, improve the quality of medical service, but also be an important reference for the formulation of the reform strategy of public hospitals in China. The purpose of this paper is to pass to the large three level armour. In order to explore the value of the recurrent system model in the analysis of hospitalization expenses in large comprehensive hospitals and to understand the influencing factors of the hospitalization expenses in large comprehensive hospitals, this study provides the basis for the effective use of health resources, reducing the economic burden of the society and patients, and formulating the rational health policy. The method of point timing is used to collect all cases of hospitalized cases in a class three grade a general hospital of Guangxi. Patients with incomplete information are eliminated, all the information and inpatient information of qualified medical records are introduced into Excel 2016, and the database of medical records is set up. On the basis of descriptive study of the data, a single factor analysis, a recursive system model combined with the road is used. The total hospitalization cost, the large amount of hospitalization expenses and the main disease cost were analyzed. The main composition and important factors of the hospitalization expenses of the large comprehensive hospital were discussed. The recursive system model and the path map analysis were completed by the SPSS 18 software and the Amos22.0 software. Results: the results showed the patients in the large and comprehensive three a hospital of this study. The average hospitalization day was 8 days (median) and the average hospitalization cost was 6245.01 yuan (median). The average median age was 50.92 years old and the largest number of people over 60 years old, accounting for 52.42% of the 35.28%. women's hospitalization, higher than the male's 47.58%. The per capita hospitalization cost was higher than that of the women under the.1 million yuan, 73.14%, and more than 50 thousand yuan. The number of cases accounted for 2.70%; the cost of hospitalization was from high to low (38.29%), material fee (15.1%), treatment fee (14.06%), laboratory fee (12.64%), operation fee (7.13%), inspection fee (6.58%), other expenses (5.3%), and nursing fee (0.90%). The 80.09%. hospitalized diseases, which accounted for the total hospitalization expenses of four, accounted for the largest number of tumor, accounting for 20.03%.. It is a disease of circulatory system, and the third is digestive system disease. The first three of the average hospitalization expenses are tumor (9335.88 yuan), injury and poisoning (8221.25 yuan), and circulatory system disease (7791.07 yuan). According to the statistical results, the length of hospitalization is the first influence factor of the average hospitalization expenses. The most influential factors are the days of hospitalization, surgery, rescue, age, and tumor. The total effect of the large amount of hospitalization costs is the number of hospitalization days, the rescue, the respiratory system disease and the operation. Conclusion: the composition of the hospitalization expenses of the three a general hospital is still the highest, and the medical staff's technical service value is low. Chronic non communicable diseases such as circulatory system disease account for a large proportion of chronic non communicable diseases, such as high cost of hospitalization, large cost of large amount of hospitalization, high cost, significant increase in material cost. The effect of hospitalization days on hospitalization costs is the most, and the average length of hospitalization is the key to the growth of control costs. Surgery, rescue, age, and higher hospitalization costs for cancer patients are relatively high. The results show that the recursive system model can better reflect the influencing factors of the main factors of hospitalization costs, and the regression analysis of many factors has some advantages, which can help us to dig out the direct and indirect influence factors of hospitalization expenses and take more favorable cost control measures. And ways.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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