摘要
目的探讨DRG付费背景下医院感染对肺癌患者的经济负担及具体影响路径。方法回顾性收集某医院2023年1月—2024年6月肺癌患者病案首页及医院感染系统数据,依据是否发生医院感染分组并进行倾向评分匹配,采用灰色关联法分析患者住院费用内部各因素间的关联程度;采用多因素线性回归和门槛回归模型探讨医院感染对住院费用的影响;应用中介效应模型探究住院日数的中介作用。结果2808例肺癌治疗患者医院感染发病率为5.91%。匹配后纳入126组数据,感染部位以呼吸系统为主(60.32%),导管相关血流感染患者住院费用最高,为142582.01元;医院感染组患者药品费占比最高(27.89%),诊断费与人均住院费用的关联度最大(0.946)。多因素线性回归结果显示,医院感染可导致肺癌患者平均住院费用增加47203.27元,住院日数增加17.89 d;住院日数在医院感染对住院费用的影响中起部分中介作用,中介效应占比53.30%。门槛效应模型显示,住院日数超过19 d时医院感染对费用的促进作用显著,且日数越长影响程度越大。结论医院感染能通过延长住院日数显著增加患者的经济负担,应合理管控药品费和诊断费的支出,优化感染患者的住院费用结构,体现医务人员的知识和技术劳务价值,规范医疗流程,加强医院感染防控。
ObjectiveTo explore the impact of healthcare-associated infection(HAI)on the economic burden of lung cancer patients and specific impact pathways under the background of diagnosis-related group(DRG)payment.Methods Data from the home page of medical record and HAI system of lung cancer patients in a hospital from January 2023 to June 2024 were collected retrospectively.Based on the occurrence of HAI,patients were grouped and matched according to propensity score.Correlation among various factors in patient's hospitalization expense was analyzed using grey correlation method.The impact of HAI on hospitalization expense was explored by multivariate linear regression and threshold regression models.The mediation effect of length of hospital stay was explored by mediation effect model.Results The incidence of HAI in 2808 lung cancer patients was 5.91%.After matching,data from 126 pairs of patients were included in the analysis,with the respiratory system being the major infection site(60.32%).Patients with catheter-related bloodstream infection had the highest hospitalization expense(142582.01 Yuan).In the HAI group,the proportion of medicine expense was the highest(27.89%),and diagnostic expenses had the highest correlation with hospitalization expenses(0.946).Multivariate linear regression results showed that HAI could result in an increase in the average hospitalization expense of lung cancer patients by 47203.27 Yuan and an extension of the length of hospital stay by 17.89 days.The length of hospital stay played a partial mediating role in the impact of HAI on hospitalization expense,with the mediating effect accounting for 53.30%.The threshold effect model showed that HAI had a significant promoting effect on the expense when the length of hospital stay exceeded 19 days,and the longer the length of hospitalization,the greater the impact.ConclusionHAI can significantly increase the economic burden on patients by prolonging the length of hospital stay.It is necessary to control the expenditure of medication and diagnostic expenses rationally,optimize the hospitalization expense structure of infected patients,reflect the value of knowledge and technical labor of healthcare workers,standardize medical procedures,as well as strengthen HAI prevention and control.
作者
王莹
金美娟
李慧
吴雪娟
WANG Ying;JIN Meijuan;LI Hui;WU Xuejuan(Department of Infection Management;Department of Thoracic Surgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《中国感染控制杂志》
北大核心
2025年第12期1829-1837,共9页
Chinese Journal of Infection Control
基金
国家自然科学基金(72074123)
2024年度江苏省医院协会医院管理创新研究重点课题(JSYGY-2-2024-249)
2023年度江苏省医院协会医院管理创新研究课题(JSYGY-3-2023-111)。
关键词
医院感染
肺癌
门槛效应模型
中介分析
灰色关联分析
healthcare-associated infection
lung cancer
threshold effect model
mediation analysis
grey correlation analysis
