摘要
目的探讨我国南方特别是广东地区老年神经退行性变性病(NDDs)住院患者的特点及影响患者医疗费用的相关因素。方法回顾性分析广州医科大学附属第一医院电子健康数据库收录的自2010年1月至2019年12月住院的7231例≥65岁的NDDs患者的病案资料(包括性别、年龄、入院途径、主诉、住院时间、出院转归方式及医疗费用等信息),并以患者医疗费用的中位数(2.1345万元)为界将患者分为低费用(<2.1345万元)组(n=3456)和高费用(≥2.1345万元)组(n=3775),采用单因素Logistic回归分析及多因素Logistic回归分析筛选老年NDDs住院患者医疗费用的影响因素及独立影响因素。结果(1)老年NDDs患者入院的高峰年龄段为70~79岁(占比40.96%),入院途径以门诊为主(占比56.70%),住院时间集中于8~14 d(占比44.50%)。(2)2010~2019年的数据显示,老年NDDs住院患者数逐年增多,住院时间总体下降,医疗费用逐渐升高;入院原因中,感染、血压异常及水电解质代谢紊乱的比例下降,心脏疾患、脑血管意外及精神心理疾病的比例上升,骨折/外伤/创伤的比例总体较为平稳;出院转归方式中,归家照料的比例及死亡比例下降,转往其他医疗/社区机构的比例增高。(3)入住重症监护室、住院时间、糖尿病、院内感染、慢性肾病、泌尿系感染、跌倒、体质量指数及抗胆碱类药均为老年NDDs住院患者医疗费用的独立影响因素(P<0.05)。结论NDDs的发病呈老龄化趋势,患病人数及其医疗费用逐年增长,但住院天数逐渐减少。鉴于影响该病医疗费用的相关因素较多,建议临床上针对疾病的主要影响因素制定相应的规范化治疗方案。
Objective To investigate the characteristics of senile neurodegenerative diseases(NDDs)inpatients in south China,especially in Guangdong province,and explore the influencing factors for their medical expenses.Methods The medical records of 7231 patients with NDDs≥65 years were collected in the electronic health database of our hospital from January 2010 to December 2019,including gender,age,admission ways,chief complaints,length of hospital stays and medical expenses.On the basis of median of the medical expenses(21345 yuan)of these patients,they were divided into low cost(<21345 yuan)group and high cost(≥21345 yuan)group.Univariate Logistic analysis and multivariate Logistic regression analysis were conducted to screen the influencing factors for medical expenses and the independent influencing factors.Results(1)The main age group of geriatric inpatients with NDDs were 70-79 years(40.96%);the admission source was mainly outpatient(56.70%),and length of hospital stays of a large percent of patients(44.50%)were 8-14 d.(2)From 2010 to 2019,the number of hospitalized geriatric patients with NDDs showed an increasing trend year by year,the overall trend of length of hospital stays was shortened,and the medical expenses showed gradual increase;the causes of hospitalization,percentages of patients caused by infection,abnormal blood pressure and water-electrolyte metabolism disturbances showed decreased trend,percentages of patients caused by heart diseases,cerebrovascular accidents and mental-psychological diseases showed increased trend,and the proportions of patients caused by fracture/trauma/wound injuries were generally stable.The proportion of patients returning home and mortality rate after hospital discharge were declined,and the proportion of patients returning to other medical or community institutions was increased.(3)Living in ICU,length of hospital stays,diabetes,nosocomial infection,chronic kidney disease,urinary tract infection,tumble,body mass index,and anticholinergic drugs were independent risk fac
作者
李桂花
邱杰雯
叶庞海
张芷玲
彭国优
周苗苗
卢林
刘汉群
郭文苑
刘新通
徐评议
Li Guihua;Qiu Jiewen;Ye Penghai;Zhang Zhiling;Peng Guoyou;Zhou Miaomiao;Lu Lin;Liu Hanqun;Guo Wenyuan;Liu Xintong;Xu Pingyi(Department of Neurology,Guangdong Second People's Hospital,Guangzhou 510317,China;Department of Neurology,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2020年第11期1134-1141,共8页
Chinese Journal of Neuromedicine
基金
国家重点研发项目(2016YFC1306601、2017YFC1310300)
国家自然科学基金(81870992、81870856、U1603281、82071416)
广东省自然科学基金自由申请项目(2018A030313649)
广州市协同创新重大专项(201803040020)
广州市临床医疗重大技术项目(2019ZD09)。
关键词
神经退行性变性病
老年人
住院特点
医疗费用
Neurodegenerative disease
Geriatric
Hospitalization characteristic
Medical expenses
