摘要
目的通过分析乳腺癌住院患者住院费用的构成及影响因素,为合理控制住院费用、优化卫生政策提供参考依据。方法收集广州市某三级医院2018年1月1日-2022年12月31日期间出院的20529例乳腺癌患者住院病案首页信息,采用灰色关联分析法评估住院费用与各单项费用之间的关联程度,采用Shapley值分解法分析住院费用影响因素及其贡献率。结果非参数检验结果显示患者年龄、出院年份、病例分型、住院次数、住院天数、是否手术、药占比、报销比与住院费用之间有统计学差异,P<0.05。乳腺癌患者平均住院费用为17040.26元,药品费用占50.76%。关联度排在前3位的分别是:药品费0.9932、医疗服务费0.9930、护理费0.9929。Shapley值分解显示,住院天数对乳腺癌患者住院费用的贡献率最高,占64.14%,其次为是否手术占19.09%、住院次数占6.02%、病例分型占4.19%、药占比占3.07%。结论减少药品费用占比、缩短住院天数是控制住院费用的关键,医院应规范医师诊疗行为、完善临床路径、优化治疗流程,减少术前术后无效住院日,降低住院费用。
Objectives To analyze the composition of hospitalization costs and the influencing factors for inpatients with breast cancer,provide data support and reference for the rational reduction of hospitalization costs and the formulation of cost control measures.Methods To collect the information of front page of medical records for 20,529 breast cancer patients from a tertiary hospital in Guangzhou,spanning the period from January 1st,2018,to December 31st,2022.The Shapley value decomposition was used to analyze the influencing factors and their contribution rate of hospitalization costs,while gray relational analysis assessed the correlation between hospitalization costs and individual cost items.Results The results of non-parametric test showed that there were statistical differences among age,discharge year,case type,hospitalization frequency,hospitalization days,surgery,drug proportion,reimbursement ratio and hospitalization expenses(P<0.05).The average hospitalization cost for breast cancer patients was 17040.26,which was dominated by the cost of medication(50.76%),with a downward trend in all costs over the years,and the expenses showed a decreasing trend year by year.Gray relation analysis showed drug costs had the highest correlation with hospitalization costs(correlation coefficient:0.9932),followed by medical service costs(0.9930)and nursing costs(0.781).The Shapley value decomposition results showed that the length of hospitalization had the highest contribution rate to the hospitalization expenses of breast cancer patients(64.14%),followed by whether to undergo surgery(19.09%),number of hospitalizations(6.02%),case classification(4.19%),drug proportion(3.07%).Conclusions Reducing the proportion of drug costs and shortening the length of hospital stays were the priority to control hospitalization costs.Hospitals should standardize the prescribing practices of physicians,improve clinical pathways,and optimize treatment processes to minimize ineffective hospital days before and after surgery,thereby reducing the overall inpatient costs.
作者
周春玲
钱锡红
李静华
Zhou Chunling;Qian Xihong;Li Jinghua(School of Public Health,Guangzhou Medical University,Guangzhou 511436,Guangdong Province,China;不详)
出处
《中国病案》
2024年第12期39-43,共5页
Chinese Medical Record
基金
广东省高校基于大数据利用的卫生健康治理哲学社会科学重点实验室(2023WSY007)
广东省哲学社会科学规划2022年度一般项目《提升基本医保制度公平和效率的策略研究——以广东省为例》(GD22CYJ27)。
关键词
乳腺癌
住院费用
影响因素
Shapley值分解
Breast cancer
Hospitalization costs
Influencing factors
Shapley value decomposition
