摘要
目的:分析大额住院费用病例的特征及费用影响因素。方法:根据5 497例大额住院费用病例数据,运用单因素分析法分析各因素对大额住院费用的影响,并使用结构方程模型进行验证。结果:大额住院费用病例的例均费用为14.03万元(约为普通病例的8.5倍),平均DRG权重为8.10(是普通病例的4.26倍);病例的性别、年龄、住院天数、科室类别及主诊断大类分组对其住院费用有显著影响。结构方程模型验证结果显示,DRG权重对费用的直接路径影响较小,住院天数是大额住院费用的最大影响因素,其他因素对住院费用的影响很小。结论:建立基于临床路径的DRG病种管理模式,缩短平均住院日,合理降低药品和耗材费用占比,对异常病例进行专项剖析、重点监控,从而实现精准控费。
Objective To analyze the characteristics and influencing factors of large inpatient expenses cases.Methods According to the data of 5 497 cases of large inpatient expenses,the influence of various factors on large inpatient expenses was analyzed by univariate analysis,and the structural equation model was used to verify these influences.Results The average cost of large inpatient cases was 140,300yuan(about 8.5 times that of ordinary cases),and the average DRG weight was 8.10(4.26 times that of ordinary cases).Gender,age,length of hospital stay,department category and main diagnosis category grouping of cases had a significant impact on their inpatient costs.Structural equation model showed that DRG weights had little effect on the direct path of costs,while days of hospital stay was the most influential factor in large inpatient costs.And other factors had little impact on hospitalization costs.Conclusion It is suggested to establish a DRG disease management model based on clinical pathways,shorten the average hospital stay,reasonably reduce the proportion of drug and consumable costs,conduct special analysis and focus monitoring on abnormal cases,so as to realize precise cost control.
作者
褚琦
吴尔律
谢金亮
丘雄江
陈凤磊
CHU Qi;WU Erlyu;XIE Jinliang;QIU Xiongjiang;CHEN Fenglei(The First Affiliated Hospital of Guangxi Medical University,Nanning Guangxi 530021,China;不详)
基金
广西医疗卫生适宜技术研究与开发项目“公立医院支付方式的改革与对策研究”(S201525)
广西壮族自治区卫生健康委员会自筹经费科研课题“基于数据驱动的医院运营管理系统建设研究”(Z20200925)。
关键词
大额住院费用
影响因素
结构方程模型
high inpatient expense
influencing factor
structural equation model
