急性心肌梗死患者住院费用影响因素分析

目的：通过对北京大学第一医院2004年出院第一诊断为“急性心肌梗死”的全部住院患者医疗费用的调查，旨在找出影响住院费用的主要因素，提出降低患者住院费用的对策，以减轻患者负担，控制医疗费用过度增长，为更有效地利用卫生资源、内科系统疾病按病种付费的可行性提供基础。方法：采用回顾性调查方法，对所有病例按设计好的调查表进行摘录、入机，逻辑检错后，用EXECEL、SAS8．2软件进行分析，采用单因素和多因素统计方法对数据进行分析。结果：研究结果显示影响费用的主要因素是“治疗方式”，不同治疗方式患者住院费用有较大差别，通过对治疗方式进一步分层分析发现，对于药物治疗患者来说，其主要影响因素是住院天数、是否会诊及出院转归三个因素；对于介入治疗患者来说，其主要影响因素是住院天数；手术治疗患者的主要影响因素是患者伴随疾病的个数。结论：由于急性心肌梗死疾病治疗方式的选择没有客观判断指标，究竟采用哪种治疗方式取决于医生的主观判断，患者一旦接收了医生的治疗方案，基本也就决定了费用层次。因此只能依据既定治疗方式的影响因素降低住院费用，以减轻患者负担、有效地利用卫生资源，为老百姓提供符合其病情的、经济有效的最佳治疗方案，并为探讨我国实行按病种收费的测算提供依据。

ANALYSIS OF INFLUENTIAL FACTORS OF MEDICAL EXPENSE OF CUTE MYOCARDIAL INFARCTION PATIENTS

Objective:Through investigating the medication expense of patients who diagnosed as acute myocardial infarction and stayed in Peking University first Hospital in 2004,to find out the main influential factors of medication cost.And according to the factors,the resolution were in order to reduce medical expense.Methods:Retrospection methodology was adopted.The patient cases were collected and computerized by the designed survey,the data was analyzed by using univariate analysis and multivariate analysis of variance statistic approach.Results:The result of this investigation showed that the main influential factor of medical charge was 'The way of treatment'.The difference of the way of treatment for inpatients resulted in a pretty big gap among medical cost.Further analysis showed that for those who adopted medication treatment,the three key factors were the patient stays in hospital,expert diagnosis,and leaving and transferring to other hospital.For patients who used interventional therapy method,the important part of cost was how long stay in hospital;The concomitance's disease was the critical element for patients who received surgery.Conclusion:In terms of patients using different treatment,the conclusion coming from the findings is to explore the main part that influenced medical charge aimed to decrease medication expense and patient's burden and effectively utilize medical sources.At the same time,through innovative clinic study,it is capable to provide a practical and cost-saving curing methods suitable for the patients.