糖尿病足患者住院费用变化趋势及影响因素分析
发布时间：2018-07-16 19:05
【摘要】：目的:分析2002年~2013年糖尿病足(Diabetic foot,DF)患者住院费用的变化趋势及各项费用的构成比例,分析影响糖尿病足患者住院费用的因素,为进一步大规模流行病学研究、及时发现糖尿病足高危人群、有效预防和早期治疗糖尿病足、改善患者生活质量从而减少糖尿病足相关医疗支出提供依据,为国家、医保、个人减轻医药费用开支探索出新的途径。方法:1.研究对象选取2002年1月至2013年12月期间在天津医科大学代谢病医院足科住院的糖尿病(Diabetes Mellitus,DM)合并DF患者,依据入选与排除标准,共计1575例患者纳入研究。2.将12年的病人按每3年为一组平均分为A、B、C、D4组,比较4组间住院总费用的变化趋势及各项分费用的构成趋势。3.将患者的一般情况、足局部情况、糖尿病并发症及合并症情况及手术情况进行分层,比较各项目分层后住院费用的差别。4.采用多元线性回归分析进一步探讨住院费用及住院天数的影响因素并对其进行相关性检验。结果:1.1575例患者中,男性992例,女性583例,年龄范围21~91岁,平均年龄66±11岁,DM病程范围半年~40年,中位时间11.5年,DF病程范围1~417周,中位时间5周。2.A、B、C、D四组住院费用呈上升趋势,D组增长最快;住院天数有一些波动,但总体上呈下降趋势。3.四组间药费在总费用中的比重最大,呈较平缓的上涨趋势;检查费、手术费、一般治疗操作费和一次性材料费均呈上升趋势,且在总费用中所占的比例也逐渐上涨;一般医疗服务费和护理费有一些波动,但总体水平呈下降趋势,与住院天数逐渐缩短一致;其他费在四组间呈小幅上涨。除一般医疗服务费外,四组间各项费用均有显著差异(P0.05)。4.单因素分析中,年龄、糖尿病病程、溃疡病程、Hb A1c、Wagner分级、ABI、感染致病菌个数、眼部疾病、糖尿病肾病、高血压病、并发症及合并症个数及手术方式12个变量的住院费用差异有统计学意义。年龄、Hb A1c、Wagner分级、ABI、致病菌个数、脑血管疾病、眼部疾病、糖尿病肾病、血脂异常、并发症及合并症个数及手术方式11个变量的住院天数差异有统计学意义。5.多因素分析中,年龄、住院天数、溃疡病程、Wagner分级、ABI、致病菌个数、高血压病、并发症及合并症个数和手术方式进入住院费用的回归模型中。年龄、Hb A1c、Wagner分级、ABI、并发症及合并症个数、手术方式进入住院天数的回归模式。6.住院费用与住院天数的相关性检验中,Spearman相关系数为0.856,P=0.0000.05,结果有显著性,住院费用与住院天数呈正相关。结论:DF住院费用巨大,且呈上涨趋势,其中以药费所占比例最大。不同临床特征的DF,住院费用有很大不同。年龄、溃疡病程、Hb A1c、住院天数、Wagner分级、ABI、感染致病菌个数、高血压病、并发症及合并症个数及手术情况是影响住院费用的独立因素。其中,年龄、Wagner分级、ABI、并发症及合并症个数、手术情况既可以直接影响住院费用,又可以通过住院天数间接影响住院费用;溃疡病程、感染致病菌个数及高血压病直接影响住院费用;Hb A1c通过住院天数间接影响住院费用。加强足病教育宣传,定期检查DM患者足病变的危险因素并及时矫正,能显著降低DF的发生率和降低有关费用。
[Abstract]:Objective: to analyze the change trend of hospitalization expenses for patients with Diabetic foot (DF) in 2002 ~2013 and the proportion of various expenses, analyze the factors that affect the hospitalization expenses of diabetic foot patients, and to find out the high risk population of diabetic foot in time for further large-scale epidemiological study, and improve the effective prevention and early treatment of diabetic foot. The quality of life to reduce diabetic foot related medical expenditure provides a basis for the state, medical insurance, and individuals to reduce the cost of medical expenses to explore a new way. 1. subjects selected from January 2002 to December 2013 in the Medical University Of Tianjin metabolic hospital foot hospital diabetes (Diabetes Mellitus, DM) combined DF patients, According to the criteria of admission and exclusion, a total of 1575 patients were included in the study.2. for 12 years in a group of 3 years as an average of A, B, C, D4, and compared the trend of the total cost of hospitalization between the 4 groups and the trend of the composition of the expenses. The general condition, the foot local condition, the diabetic complication and the complication and the operation situation were carried out. The difference of hospitalization expenses after stratification of each item.4. was analyzed by multiple linear regression analysis to further explore the influencing factors of hospitalization costs and days of hospitalization. Results: among the 1.1575 patients, 992 were male, 583 women, age 21~91 years, the average age was 66 + 11 years, and the range of DM course was half a year ~40 years. The duration of 11.5 years was 11.5 years, the course range was 1~417 weeks, the median time was 5 weeks.2.A, the four groups of B, C, and D were on the rise, the D group grew fastest, the number of hospitalization days had some fluctuations, but the overall decline trend was the largest proportion in the total cost in the total cost of the.3. four, and the cost of inspection, operation, general treatment and one time. The cost of sex material increased, and the proportion of the total cost increased gradually; the general medical service fee and nursing charge had some fluctuations, but the overall level showed a downward trend, and the number of hospitalization days decreased gradually. The other fees were slightly higher among the four groups. Except for the general medical service charge, the expenses of the four groups were significantly different ( P0.05) in.4. single factor analysis, age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, ocular diseases, diabetic nephropathy, hypertension, complications and the number of complications and surgical methods were statistically significant. Age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, brain blood There were significant differences in the number of hospitalization days between 11 variables, tube disease, ocular disease, diabetic nephropathy, dyslipidemia, complications, complications, complications, complications and surgical methods. Age, days of hospitalization, course of ulcers, Wagner classification, ABI, number of pathogenic bacteria, hypertension, complications and complications and complications and surgical methods entered the hospital. The regression model of the cost. Age, Hb A1c, Wagner classification, ABI, complications and complication, the operation mode entered the hospitalization days, the correlation of.6. hospitalization expenses and hospital days was 0.856, P=0.0000.05, the result was significant, the hospitalization cost was positively related to the hospital days. Conclusion: DF hospitalization fee. There was a huge and rising trend, with the largest proportion of drug charges. DF with different clinical features was very different. Age, the course of the ulcer, the Hb A1c, the number of days of hospitalization, the Wagner grade, the ABI, the number of pathogenic bacteria, the hypertension, the complication and the number of complications and the operation were the independent factors of the hospitalization expenses. Wagner classification, ABI, complications and complications, the operation can directly affect the cost of hospitalization, but also indirectly affect hospitalization expenses through the days of hospitalization; the course of ulcers, the number of infection pathogenic bacteria and hypertension directly affect the hospitalization expenses; Hb A1c indirectly affects hospitalization expenses through the number of days in hospital. Checking the risk factors and timely correction of foot lesions in DM patients can significantly reduce the incidence of DF and reduce the related costs.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
本文编号：2127381
[Abstract]:Objective: to analyze the change trend of hospitalization expenses for patients with Diabetic foot (DF) in 2002 ~2013 and the proportion of various expenses, analyze the factors that affect the hospitalization expenses of diabetic foot patients, and to find out the high risk population of diabetic foot in time for further large-scale epidemiological study, and improve the effective prevention and early treatment of diabetic foot. The quality of life to reduce diabetic foot related medical expenditure provides a basis for the state, medical insurance, and individuals to reduce the cost of medical expenses to explore a new way. 1. subjects selected from January 2002 to December 2013 in the Medical University Of Tianjin metabolic hospital foot hospital diabetes (Diabetes Mellitus, DM) combined DF patients, According to the criteria of admission and exclusion, a total of 1575 patients were included in the study.2. for 12 years in a group of 3 years as an average of A, B, C, D4, and compared the trend of the total cost of hospitalization between the 4 groups and the trend of the composition of the expenses. The general condition, the foot local condition, the diabetic complication and the complication and the operation situation were carried out. The difference of hospitalization expenses after stratification of each item.4. was analyzed by multiple linear regression analysis to further explore the influencing factors of hospitalization costs and days of hospitalization. Results: among the 1.1575 patients, 992 were male, 583 women, age 21~91 years, the average age was 66 + 11 years, and the range of DM course was half a year ~40 years. The duration of 11.5 years was 11.5 years, the course range was 1~417 weeks, the median time was 5 weeks.2.A, the four groups of B, C, and D were on the rise, the D group grew fastest, the number of hospitalization days had some fluctuations, but the overall decline trend was the largest proportion in the total cost in the total cost of the.3. four, and the cost of inspection, operation, general treatment and one time. The cost of sex material increased, and the proportion of the total cost increased gradually; the general medical service fee and nursing charge had some fluctuations, but the overall level showed a downward trend, and the number of hospitalization days decreased gradually. The other fees were slightly higher among the four groups. Except for the general medical service charge, the expenses of the four groups were significantly different ( P0.05) in.4. single factor analysis, age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, ocular diseases, diabetic nephropathy, hypertension, complications and the number of complications and surgical methods were statistically significant. Age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, brain blood There were significant differences in the number of hospitalization days between 11 variables, tube disease, ocular disease, diabetic nephropathy, dyslipidemia, complications, complications, complications, complications and surgical methods. Age, days of hospitalization, course of ulcers, Wagner classification, ABI, number of pathogenic bacteria, hypertension, complications and complications and complications and surgical methods entered the hospital. The regression model of the cost. Age, Hb A1c, Wagner classification, ABI, complications and complication, the operation mode entered the hospitalization days, the correlation of.6. hospitalization expenses and hospital days was 0.856, P=0.0000.05, the result was significant, the hospitalization cost was positively related to the hospital days. Conclusion: DF hospitalization fee. There was a huge and rising trend, with the largest proportion of drug charges. DF with different clinical features was very different. Age, the course of the ulcer, the Hb A1c, the number of days of hospitalization, the Wagner grade, the ABI, the number of pathogenic bacteria, the hypertension, the complication and the number of complications and the operation were the independent factors of the hospitalization expenses. Wagner classification, ABI, complications and complications, the operation can directly affect the cost of hospitalization, but also indirectly affect hospitalization expenses through the days of hospitalization; the course of ulcers, the number of infection pathogenic bacteria and hypertension directly affect the hospitalization expenses; Hb A1c indirectly affects hospitalization expenses through the number of days in hospital. Checking the risk factors and timely correction of foot lesions in DM patients can significantly reduce the incidence of DF and reduce the related costs.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
【参考文献】
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1 阎玉霞;;住院病人92674例住院费用的影响因素分析[J];第一军医大学分校学报;2005年02期
，本文编号：2127381
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