2012-2016年952例包虫病患者住院费用及影响因素分析

发布时间：2018-07-16 21:53

【摘要】：目的:调查2012-2016年青海省人民医院包虫病住院患者的病历资料与住院费用,分析青海省人民医院包虫病患者住院费用总体状况,明确影响住院费用的主要因素,为我省包虫病医疗防治策略的制定和完善提供理论依据。方法:收集青海省人民医院2012年1月至2016年12月的所有包虫病住院患者病历资料,包括一般信息、临床资料信息及住院费用等信息,填写自行编制的青海省包虫病住院病例回顾性调查表,采用Epidata3.0建立青海省包虫病住院患者信息数据库,对所有调查表进行双录入并做一致性检验,所有合格调查表最终导入SPSS17.0软件进行分析。应用非参数秩和检验对各影响因素(如病灶大小、是否手术等)进行单因素分析,应用多元线性回归进行多因素分析,明确包虫病患者住院费用的主要影响因素。结果:1.基本情况青海省人民医院2012-2016年共收治包虫病患者1,096例,年均住院病例数为219例/年,符合本研究要求的有952例,其中囊型和泡型包虫病患者分别占79.41%(756例)、20.59%(196例);患者居住地以玉树州、果洛州为主,分别占23.21%(221例)、19.43%(185例),再次为西宁市,占14.08%(134例);患者最小为7岁,最大为90岁,以31—45岁年龄段居多;患者以藏族居多,占70.20%(668例);职业分布可见,以农牧民最多,占80.25%(764例);文化程度上以文盲为主,占60.08%(572例);医保患者比例较高,占83.40%(794例);大多数患者住院天数为10—19天;手术患者占51.79%(493例),治愈与好转率为95.94%(473例)。2.住院费用单因素分析调查显示,住院费用中位数2012年为16,370.60元,2016年为21,524.40元,各年度间住院费用无显著性差异(P0.05);分析表明,住院费用中位数中蒙古族为23,035.75元,藏族为17,779.25元,撒拉族仅为9,907.25元,民族间住院费用无显著差异(P0.05);学生和牧民住院费用中位数分别为20,359.10元、19,202.75元,职业间住院费有显著差异(χ2=17.230,P=0.0160.05);病灶大小以10cm住院费用中位数最高,为19,708.60元,其次为5—10cm 17,547.20元,不同病灶大小住院费用有显著性差异(χ2=14.556,P=0.0010.05);肝功能分级以Child B级住院费用中位数最高为19,317.20元,不同肝功能分级住院费用有显著性差异(χ2=8.694,P=0.0130.05);有并发症患者的住院费用中位数高于无并发症患者分别为26,438.40元和16,013.30元,二者住院费用有显著性差异(Z=-7.958,P=0.0000.05);手术患者和非手术患者住院费用分别为24,681.30元、9,556.85元,二者间有显著性差异(Z=-18.533,P=0.0000.05);疾病转归中,治愈患者住院费用最高,为24,771.55元,不同疾病转归住院费用有显著性差异(χ2=291.890,P=0.0000.05);手术患者中,泡型包虫病患者和囊型包虫病住院费用分别为35,659.40元和23,389.80元,二者间有显著差异(Z=-5.960,P=0.0000.05);住院费用中位数医保患者高于自费患者,依次为18,219.50元、15,112.25元,医保与自费包虫病患者住院费用差别有统计学意义(Z=-2.139,P=0.0320.05)。囊型和泡型包虫病患者不同影像分型住院费用差异不大(P0.05)。3.住院费用构成情况本研究中住院费用分析指标包括药物费用(西药、中药以及草药等)、检查费用、耗材费用、手术费用以及其它费用,2012-2016年住院费用构成中药品费、检查费和耗材费分别为39.60%、28.84%、15.05%。4.影响因素包虫病患者住院费用的影响因素是多方面的,分析结果显示,入院年份(X7)、住院天数(X2)、是否手术(X8)、疾病转归(X13)、年龄(X1)、有无并发症(X6)、入院时肝功能Child-Pugh分级(X12)、职业(X10)是主要影响因素。包虫病住院费用影响因素回归方程为:Y=-6,438,918.766+81.097X1+1,195.768X2-4,004.19X6+3,198.722X7-4,995.644X8-7,423.869X10+2,999.192X12+1,435.965X13(R2=0.52,F=35.35,P=0.0000.05)。结论:1.明确了青海省包虫病住院患者的人群和地区分布特征,包虫病患者的构成在民族、职业、文化程度、年龄、区域上都存在明显差异,民族以藏族最多,职业以农牧民最多,文化程度以文盲最多,年龄以青中年最多,区域以玉树州、果洛州最多。2.明确了青海省包虫病住院患者未愈率偏高的原因,因为就诊时多数患者已处于病程中晚期,致使住院患者手术率低,未愈率高,患者预后欠佳。3.明确了青海省包虫病患者的住院费用构成基本情况,以药品费、检查费、耗材费为主。4.明确了包虫病患者住院费用主要影响因素,依次为住院天数、入院年份、是否手术、疾病转归、是否并发症、年龄、入院时肝功能Child-Pugh分级、职业。
[Abstract]:Objective: To investigate the medical records and hospitalization expenses of the hospitalized patients with echinococcosis in Qinghai People's Hospital for 2012-2016 years, analyze the overall status of the hospitalization expenses of the patients with echinococcosis in the hospital and clarify the main factors that affect the hospitalization expenses, and provide the theoretical basis for the establishment and improvement of the medical treatment strategy of echinococcosis in our province. Method: collecting Qinghai All the medical records of all echinococcosis patients in the provincial people's Hospital from January 2012 to December 2016, including general information, clinical information and hospitalization expenses, filled in a retrospective questionnaire of the hospitalized cases of echinococcosis in Qinghai Province, and established the information database of inpatient in Qinghai province by Epidata3.0. Double entry and consistency test were carried out. All qualified questionnaires were finally introduced into SPSS17.0 software. Single factor analysis was carried out with non parametric rank sum test on the influence factors such as the size of the lesion, or not surgery, and multiple linear regression was used to analyze the main factors affecting the hospitalization expenses of hydatidosis patients. Results: 1. in Qinghai People's Hospital, there were 1096 cases of echinococcosis in Qinghai People's Hospital in 2012-2016 years. The average annual number of hospitalized cases was 219 / year, and 952 cases met the requirements of this study. 79.41% (756 cases) and 20.59% (196 cases) were cystic and alveolar echinococcosis, and the place of residence was mainly in Yushu and fruit, and 23.21% (221. 19.43% (185 cases), again in Xining, 14.08% (134 cases); the minimum of the patients was 7, the largest was 90 years old, with the majority of the age 31 to 45 years, the majority of the Tibetans, and 70.20% (668 cases); the occupational distribution was visible, the majority of the farmers and herdsmen, accounting for 80.25% (764 cases); the cultural degree was mainly illiterate, accounting for 60.08% (572 cases); the proportion of medical insurance patients was high. % (794 cases); most patients were hospitalized for 10 to 19 days; 51.79% (493 cases) were operated by patients (493 cases), and the cure and improvement rate of 95.94% (473 Cases) hospitalization cost single factor analysis showed that the median of hospitalization costs was 16370.60 yuan in 2012 and 21524.40 in 2016, and there was no significant difference in hospitalization expenses between each year (P0.05), and the analysis showed hospitalization fee. The median Mongolian nationality was 23035.75 yuan, the Tibetan was 17779.25 yuan, the Sarah nationality was only 9907.25 yuan, and the hospitalization expenses of the students and the herdsmen were 20359.10 yuan and 19202.75 yuan, respectively (P0.05), and the hospitalization fees of students and herdsmen were significantly different (x 2= 17.230, P=0.0160.05), and the size of the lesion was in the middle of the hospitalization expense of 10cm. The highest number was 19708.60 yuan, followed by 5 - 10cm 17547.20 yuan. The cost of hospitalization for different lesion sizes was significantly different (x 2=14.556, P=0.0010.05); the median of liver function classification at the median of Child B hospitalization costs was 19317.20 yuan, and the hospitalization expenses of different liver function grades were significantly different (x 2=8.694, P=0.0130.05); patients with complications had complications. The median of hospitalization costs was 26438.40 yuan and 16013.30 yuan higher than those without complications. The hospitalization expenses of the two patients were significantly different (Z=-7.958, P=0.0000.05); the hospitalization expenses of the patients and the non operative patients were 24681.30 yuan, 9556.85 yuan, respectively (Z=-18.533, P=0.0000.05). The cost of hospital was 24771.55 yuan, and the hospitalization expenses of different diseases were significantly different (x 2=291.890, P=0.0000.05). The hospitalization expenses of the patients with echinococcosis and cystic echinococcosis were 35659.40 yuan and 23389.80 yuan respectively, and there were significant differences between the two patients (Z= -5.960, P=0.0000.05); the median of hospitalization expenses was higher than that of the patients. 18219.50 yuan, 15112.25 yuan, medical insurance and self funded echinococcosis patients were in a significant difference (Z=-2.139, P=0.0320.05). The difference of hospitalization expenses of different imaging types of cystic and alveolar echinococcosis patients was not significant (P0.05).3. hospitalization expenses Medicine, traditional Chinese medicine and herbal medicine etc.), inspection expenses, cost of consumables, operation cost and other expenses, 2012-2016 years of hospitalization expenses constitute the cost of Chinese medicine, the cost of inspection and consumables are 39.60%, 28.84%, the influencing factors of the hospitalization expenses of the patients with echinococcosis by 15.05%.4. are many aspects, the results of analysis show that the admission year (X7), the days of hospitalization ( X2), whether surgery (X8), disease transfer (X13), age (X1), complication (X6), liver function Child-Pugh classification (X12) at admission and occupation (X10) are the main factors. The regression equation of the influencing factors of the hospitalization expenses of hydatidosis is: Y=-6438918.766+81.097X1 +1195.768X2-4004.19X6+3198.722X7-4995.644X8-7423.869X10+2999.192X12+1435.96 5X13 (R2=0.52, F=35.35, P=0.0000.05). Conclusion: 1. the population and regional distribution characteristics of echinococcosis in Qinghai province were clearly defined. The constitution of echinococcosis had obvious differences in ethnic, professional, cultural, age, and area. The ethnic group was the most Tibetan, the vocational and pastoral people were the most, the cultural degree was the most illiterate, the age was green and middle age. Most, in the region of Yushu and the largest.2. in the state of fruit in the state of Qinghai, it is clear that the unhealed rate of echinococcosis in Qinghai is high, because the majority of the patients are in the middle and late period of the disease, resulting in low rate of operation, high unhealing rate and poor prognosis of the patients, and the basic condition of the hospitalization expenses of the patients with echinococcosis in Qinghai province is made clear. The main factors affecting the hospitalization cost of echinococcosis patients were.4., inspection fee and cost of consumables, which were hospitalization days, hospitalization years, surgery, disease outcome, complications, age, Child-Pugh classification of liver function and occupation at admission.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.323;R532.32

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