摘要
目的测算公立医院应用连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的成本,分析影响成本的主要因素,为CRRT技术的优化应用提供支持,推动公立医院高质量服务的健康发展。方法2021年3月采用作业成本法选择江苏、浙江、河南、四川、新疆的5家样本医院收集临床使用情况数据,根据CRRT操作的标准流程建立成本测算模型,采用单因素敏感度分析发现影响成本的主要因素。结果5家样本医院CRRT治疗每小时成本为265.30~474.44元,平均376.81元;人力和滤器管路成本占比最大,连续静脉-静脉血液滤过和连续静脉-静脉血液透析滤过2种模式人力成本占比分别为22.90%和21.51%,滤器管路占比分别为15.07%和17.73%;机构间单位成本和成本构成差异较大。影响单位成本的因素有临床操作因素、效率因素、价格因素以及患者因素4类,其中临床操作差异是导致成本差异的首要因素。结论CRRT技术应用成本机构间差异较大,成本影响因素多,医疗机构存在成本回收困难的情况。应加强公立医院内控运营管理,建立CRRT临床操作规范,控制成本的同时提高公立医院医疗服务质量。
Objective To estimate the cost of continuous renal replacement therapy(CRRT)in public hospitals and analyze the main influencing factors of the cost,in order to provide evidence for the optimal application of CRRT technology.Methods In March 2021,activity-based costing was used to estimate and analyze the cost of CRRT,the data of which were collected from 5 hospitals in Jiangsu,Zhejiang,Henan,Sichuan and Xinjiang,and single factor sensitivity analysis was used to find the main influencing factors of the cost.Results The hourly treatment costs of CRRT in the 5 hospitals ranged from 265.30 to 474.44 yuan,with an average of 376.81 yuan.The costs of manpower and filters accounted for the top two largest proportions,the manpower cost of continuous veno-venous hemofiltration and continuous veno-venous hemodiafiltration accounted for 22.90%and 21.51%,respectively,and the filters cost of the two types of CRRT accounted for 15.07%and 17.73%,respectively.The unit cost and cost composition varied greatly between hospitals.There were four factors affecting the unit cost,namely clinical operation,efficiency,price and patient,among which clinical operation difference was the primary factor leading to cost difference.Conclusions The application cost of CRRT technology varies greatly among hospitals,and there are many factors affecting the cost.Public hospitals face great pressure in cost control.It is necessary to strengthen the internal control operation management of public hospitals,establish CRRT clinical operation standards,and improve the quality of medical services in public hospitals.
作者
史黎炜
邱英鹏
向阳
刘克军
肖月
SHI Liwei;QIU Yingpeng;XIANG Yang;LIU Kejun;XIAO Yue(China National Health Development Research Center,Beijing 100044,P.R.China;National Center for Medicine and Health Technology Assessment,Beijing 100044,P.R.China;School of Public Health,Dalian Medical University,Liaoning,Dalian 116044,P.R.China)
出处
《华西医学》
CAS
2022年第12期1818-1823,共6页
West China Medical Journal
基金
国家卫生健康委卫生发展研究中心科研课题(CNHDRC-KJ-L-2020-30)。
关键词
连续性肾脏替代治疗
成本测算
敏感度分析
Continuous renal replacement therapy
cost estimation
sensitivity analysis
