【作者】 王欣；

【导师】 张媛媛；

【作者基本信息】 大连医科大学 ， 公共卫生（专业学位）， 2023， 硕士

【摘要】 目的:本研究选取大连市某三甲医院2017-2021年胃癌患者住院费用的数据,探讨胃癌住院费用近五年随着时间变化的趋势以及构成情况,对患者基本情况、医疗支付方式和住院天数等方面进行分析,探究胃癌患者住院费用的影响因素,为降低胃癌患者住院费用、调整费用构成、优化住院服务、健全医院管理结构提供一定的理论依据。方法:本研究数据来源于大连市某三甲医院病案管理系统,从中提取出2017年1月1日-2021年12月31日所有出院主诊断为胃癌患者的基本信息和住院费用,对数据进行筛选处理后,共获得病例5289例。具体包括以下内容:基本信息包括性别、年龄、民族、婚姻状况、入院年份、医疗支付方式、住院天数等;住院费用包括总费用、药品费用、治疗费用、检查费用、手术费用、血液和血液制品费、床位费用、医用材料费用、护理费、其他费用。采用Excel对数据进行整理和校对,选择SPSS26.0和SAS9.4对数据进行统计分析,选择单因素分析、多因素分析和灰色关联分析法进行影响因素的探究。结果:1.通过对社会人口学特征和临床特征的描述,结果表明男性患者多于女性患者,男性:女性约为3:1,其中男性患者3587例,占68%,女性患者1702例,占32%;患病年龄集中在50-69岁,共3385例,占64%。住院天数<10天的患者,共3844例,占73%;患者医疗支付方式以城乡居民医疗保险为主,共3414例,占65%;其次是城镇职工医疗保险,共909例,占17%。2.该三甲医院胃癌患者人数逐年升高,年均增长率18.86%,2017-2021年住院费用均数为18,851.11元,中位数为10,055.01元,总住院费用和平均住院费用逐年增高。3.各单项费用中,总住院费用及各项费用资料均不服从正态分布,对结果的集中趋势描述选取中位数这一指标。药品费的中位数为4765.16元,其次是检查费2978.50元,中位数较低的单项费用分别为治疗费456.85元、床位费243.20元、护理费169.40元。4.经过单因素分析发现,影响胃癌患者住院费用的因素中具有统计学意义(P<0.05)的分别为性别、年龄、医疗支付方式、入院年份和住院天数,而民族、婚姻状况对住院费用的影响差异不具有统计学意义(P>0.05)。5.经过多因素分析发现,影响胃癌患者住院费用的主要因素依次为:住院天数、住院年份、医疗支付方式。多元回归模型分析结果显示F=1503.54,P<0.0001,说明该模型具有统计学意义,调整系数R~2=0.6315,表明有63.2%的因素变化可以解释住院费用的变异。结论:1.2017-2021年胃癌患者的数量逐年递增,60岁以上胃癌患者例数逐渐增多,发病率高龄化趋势明显。男性患者明显多于女性患者,男女比例为3:1。2.胃癌患者住院费用内部构成不合理,占比排名前三位的分别为药品费、医用材料费、检查费,与之相反,手术费、护理费等反映医护人员劳动价值的项目占比较低,随时间变化不大。3.影响胃癌患者住院总费用的主要因素包括住院天数、医疗支付方式、入院年份,其中,最关键的因素为住院天数,患者住院时间的长短直接影响住院费用的高低,因此要想缓解病人的疾病负担,首先要从控制住院天数入手。更多还原

【Abstract】 Objective:This study selects the data of hospitalization costs of gastric cancer patients in a third-class hospital in Dalian from 2017 to 2021,discusses the trend and structural composition of gastric cancer hospitalization expenses in the past five years,analyzes the basic situation of patients,medical payment methods and hospitalization days,explores the influencing factors of hospitalization costs of gastric cancer patients,and provides a certain theoretical basis for reducing the hospitalization costs of gastric cancer patients,adjusting the cost structure,optimizing inpatient services,and improving the hospital management structure.Methods:The data of this study came from the case management system of a tertiary hospital in Dalian,from which the basic information and hospitalization costs of all patients diagnosed with gastric cancer from January 1,2017 to December 31,2021 were extracted,and a total of 5289 cases were obtained after screening and processing the data.Specifically,it includes the following contents:basic information including gender,age,ethnicity,marital status,year of admission,medical payment method,length of hospitalization,etc.;Hospitalization costs include total costs,medicines,treatment,examinations,surgery,blood and blood products,beds,medical materials,nursing,and other expenses.Excel was used to organize and proofread the data,SPSS26.0 and SAS9.4were selected for statistical analysis,and univariate analysis,multivariate analysis and grey correlation analysis were selected to explore the influencing factors.Results:1.Through the description of sociodemographic characteristics and clinical features,the results show that there are more male patients than female patients,male:female is about 3:1,of which 3587 are male patients,accounting for 68%,and 1702 are female patients,accounting for 32%;The age of illness was concentrated in 50-69 years,a total of 3385 people,accounting for 64%.3,844 patients with<10 days of hospitalization,accounting for 73%;The medical payment methods of patients were mainly urban and rural residents’medical insurance,with a total of 3414 people,accounting for 65%;This was followed by medical insurance for urban workers,with 909people,accounting for 17%.2.The number of gastric cancer patients in the tertiary hospital has increased year by year,with an average annual growth rate of 18.86%,and the average inpatient cost from 2017 to 2021 is 18,851.11 yuan,the median is 10,055.01 yuan,and the total inpatient cost and average inpatient cost are increasing year by year.3.Among the individual costs,the total hospitalization expenses and various cost data did not follow the normal distribution,and the median index was selected as the central trend description of the results.The median cost of drugs was 4765.16 yuan,followed by examination fee of 2978.50 yuan,and the lower median single cost was456.85 yuan for treatment,243.20 yuan for bed and 169.40 yuan for nursing.4.Univariate analysis showed that the factors affecting the hospitalization cost of gastric cancer patients were statistically significant(P<0.05)gender,age,medical payment method,year of admission and length of hospitalization,while the effects of ethnicity and marital status on hospitalization cost were not statistically significant(P>0.05).5.After multi-factor analysis,it was found that the main factors affecting the hospitalization cost of gastric cancer patients were:length of hospitalization,year of hospitalization,and medical payment method.The results of multiple regression model analysis showed that F=1503.54,P<0.0001,indicating that the model was statistically significant,and the adjustment coefficient R~2=0.6315 showed that 63.2%of the factor changes could explain the variation of hospitalization costs.Conclusion:1.From 2017 to 2021,the number of gastric cancer patients increased year by year,and the number of gastric cancer patients over 60 years old gradually increased,and the incidence rate was obvious.There are significantly more male patients than female patients,with a male-to-female ratio of 3:1.2.The internal composition of hospitalization expenses of gastric cancer patients is unreasonable,accounting for the top three are drug fees,medical material costs,and examination fees,on the contrary,surgical fees,nursing fees and other items that reflect the labor value of medical staff account for relatively low proportions and do not change much with time.3.The main factors affecting the total hospitalization cost of gastric cancer patients include the number of days of hospitalization,medical payment method,and year of admission,among which,the most critical factor is the number of days of hospitalization,and the length of hospitalization of patients directly affects the level of hospitalization costs,so in order to alleviate the burden of disease of patients,we must first start from controlling the number of hospitalization days.更多还原