基于双重差分法评估按病种分值付费对恶性肿瘤患者住院费用的影响

目的分析按病种分值付费对恶性肿瘤患者住院费用的影响.方法提取厦门市某三级甲等医院2014年~2017年医保年度的涉及恶性肿瘤病例数据,通过描述性统计与双重差分法对相关医疗管理指标及病种结算情况进行分析.结果统计期间,恶性肿瘤相关疾病住院费用复合增长率(CAGR)为17.44%,本地医保住院人数、住院人次、人均住院次数高于其他患者;次均费用、次均耗材费净效应无统计学意义,平均住院天数、次均药品费用下降,个人负担费用增加;分值分段中>100的人次占比最大,为54.17%,0~100分值段CAGR最高,占77.52%,居中的300~400分值段呈负增长(CAGR-9.40%);涉及恶性肿瘤的病例结算病种700种中仅104个病种按恶性肿瘤病种结算,其中97种人次占比低于1%;本地医保全部病种结算费用为该病种平均值的75.87%.结论按病种分值付费改革有利于增强医院自主管理意识,有利于减轻参保人员个人负担水平;按病种分值付费改革控制恶性肿瘤相关疾病住院医疗费用过快增长影响有限;按病种分值付费改革加强了定点医院诊疗行为的选择性,存在诱导住院、分解住院、改变诊断排序的可能性;按病种分值付费改革病种分值计算方法应进一步优化,建议借鉴疾病诊断相关分组办法测算的标准费用作为分值计算依据,减少病种数量,并为推行DRGs收付费做好数据基础.     

1999-2007年干部病房住院患者疾病谱及其主要死因分析

目的 利用较大样本住院资料分析我院干部病房住院患者病种和死亡疾病的构成,探讨干部病房近9年疾病的发病情况和导致死亡的主要病种.方法 回顾性分析1999年1月～2007年l2月我院干部病房住院患者6 471例临床资料,疾病的诊断依据<国际疾病分类第9次修订本>,按年度对各疾病病种分布、死亡病因、患病年龄进行分析.结果 在近9年中住院患者的年龄和死亡年龄逐渐增加,呼吸道感染、冠心病、高血压和脑血管病是患者住院的主要疾病,而导致死亡的主要疾病分别是肿瘤、肺部感染、冠心病和脑血管疾病.结论 有效地控制和预防呼吸道感染、肿瘤和心脑血管疾病是今后预防保健的重点.     

基于单病种付费的分级诊疗实施效果及影响因素研究

目的：探索基于单病种付费的分级诊疗对于引导住院患者合理流动的政策实施效果,分析政策范围内住院患者机构选择的主要影响因素。方法：本研究以甘肃省渭源县新农合住院患者为研究对象,对比政策前后住院患者就医流向变化情况,并采用logistic回归分析乡级分级诊疗病种范围内住院患者就诊流向的影响因素。结果：病种分级诊疗实施后,住院患者选择乡级医疗机构的比例呈上升趋势,选择县级医疗机构的患者比例呈逐步下降趋势,住院患者县域内就诊率2016年达89.69%;分级诊疗住院病种范围内住院患者就医流向趋于合理。年龄、疾病种类、距县医院车程、患者居住地所在乡镇卫生院服务能力均为影响乡级病种范围住院患者就诊流向的重要因素。结论：基于单病种付费的分级诊疗其对政策范围内住院患者的流向起到了积极的引导作用,制定合理分级诊疗病种,提升基层医疗机构能力是保障政策发挥积极作用的关键。     

2017年某院出院患者再入院病例的统计分析

目的:了解2017年某医院住院患者出院31 d内同病种再入院的现状及其原因.方法:将某医院2017年出院31 d内再入院患者的相关信息数据导入至Excel 2010中,经整理、统计后筛查出18种住院重点疾病31d内患者因同病种再住院的例数,并进行描述性分析和单因素分析.结果:患者出院至再入院的平均间隔天数为(13.63±2.30)d,且0～15 d内再住院率为58.04％,高于16～31 d的41.96％;单因素分析发现,患者年龄、前次住院是否治愈、病种与31 d内出院再入院率差异有统计学意义(P＜0.05).结论:医院应重视中老年疾病、重症疾病、慢性病的临床防治研究工作,尽量减少31d内重复住院率,以使医疗资源得到充分的利用,医院获得更好的社会效益.     

冠脉内支架术患者住院费用影响因素及费用控制标准研究

目的 为合理控制病种费用、制定冠脉内支架术患者住院费用标准提供参考依据.方法 根据上海市某三级甲等医院2004年至2006年行冠脉内支架术患者的住院费用数据,对可能影响费用的因素进行多因素分析,并建立病种费用预测模型,测算病种的医疗保险费用控制上限,据此对2007年1～6月的患者进行费用评价.结果 1 296例冠脉内支架术患者,其手术材料费占住院费用的比例最高,达84.11%;影响冠脉内支架术患者住院费用的因素按其作用强度,依次为支架数量、住院天数、年龄、入院情况及抢救情况.2007年1～6月的患者平均住院费用低于控制中心线,且费用低于上控制线的病例数达到85%以上.结论 医院应从控制支架数量、住院天数及药品费等方面入手,降低病种医疗费用.通过制定病种费用控制标准,可加强医疗质量管理与控制.     

2003-2007年某医院恶性肿瘤住院患者构成分析

目的 分析恶性肿瘤住院患者性别、年龄及病种构成,为恶性肿瘤防治工作提供科学依据.方法 对某医院2003-2007年恶性肿瘤住院患者进行回顾性分析,采用SPSS 13.0进行统计处理.结果 5a间该医院共收治恶性肿瘤住院患者52 377例,在该医院病种顺位中居首位,其中性别比为1.7:1.男性恶性肿瘤病种构成前5位是肺癌、肝癌、胃癌、大肠癌、食管癌,女性前5位依次为乳腺癌、肺癌、卵巢癌、大肠癌、子宫癌.近5 a恶性肿瘤病例数逐年上升,平均增长速度为27.9%.结论 该医院恶性肿瘤病人呈逐年增长趋势,肺癌高居恶性肿瘤之首,乳腺癌近年来呈明显上升趋势,传统高发肿瘤肝癌、胃癌、大肠癌仍然为防治重点.     

我院30年住院病人疾病结构变化分析

目的了解1974-2003年我院住院患者的疾病构成及其变化趋势,为临床防治工作开展提供科学依据.方法整理分析我院1974-2003年住院患者的病案资料.结果妊娠分娩及产褥期并发症、损伤和中毒、肿瘤、呼吸系统疾病和消化系统疾病等为本院住院患者的主要病种.结论加强对这些常见病、多发病的防治工作,以提高广大居民的健康水平和生命质量.     

某院45-59岁住院恶性肿瘤病例统计分析△

目的：分析某三甲医院2018年至2022年中年恶性肿瘤住院患者病种构成、年龄及变化趋势,为预防干预该年龄段恶性肿瘤提供依据。方法：通过病案管理系统和SQL语句,采集该医院2018年至2022年45岁至59岁恶性肿瘤住院患者共20097例,依据ICD-10类目分类汇总病种构成,分析年龄、性别分布及疾病变化趋势。结果：45岁至59岁年龄段恶性肿瘤住院患者占恶性肿瘤总住院患者比重呈上升趋势,排名前三位的恶性肿瘤病种为肺癌（17.41%）、甲状腺癌（10.75%）和胃癌（9.33%）,前十位病种占比合计达69.62%,女性占比高于男性。多发恶性肿瘤病种随年龄变化有明显差异。结论：2018年至2022年45-59岁年龄段恶性肿瘤发病呈逐年上升趋势,进一步提高对该年龄段恶性肿瘤发病特征的认识,做好预防和诊治工作,是实施健康中国战略的重要环节之一。     

某院1990年与2009年疾病构成变化的分析

目的了解1990年与2009年某三级甲等医院住院患者的疾病构成及其变化趋势,为医院合理地配置卫生资源,完善医院管理模式,满足人民群众防病、治病提供理论依据.方法整理分析1990年、2009年住院患者的病案资料.结果 1990年与2009年疾病构成有显著性差异(P<0.01),2009年肿瘤、呼吸系统疾病、循环系统疾病为住院患者的主要病种,分别占11.89%、11.81%、10.87%.结论医院应根据医院疾病构成变化的趋势,合理配置卫生资源.     

综合性中医院7年病案死亡风险分析

目的提取住院死亡病案的特征,分析住院患者的死亡风险。方法参考文献资料,给出死亡风险定义;收集2010年至2016年所有病案进行统计,对患者性别、年龄、入院诊断等因素计算住院患者的死亡风险,由此给出研究结论。结论年龄和入院诊断病种是影响住院患者死亡风险的两个重要因素,但以病种为主,年龄为辅。     

某三级甲等中医院精神病科住院患者疾病构成分析

目的 分析某三级甲等中医院精神病科疾病构成及分布情况,为精神疾病防治和学科建设提供理论依据.方法 回顾性分析某中医院4178份精神病科住院病案首页资料,收集患者的性别、年龄、出院主要诊断、住院天数、住院费用等信息进行统计分析.结果 精神分裂症、抑郁症、焦虑症、急性应激反应和癫痫性精神病是精神病科住院患者前5位疾病,累积...     

医院急诊精神疾病患者流行病学特征

目的 ：探讨医院急诊精神疾病患者流行病学特征,为临床治疗方案选择应用提供参考。方法：采用本院自行设计的调查问卷进行资料收集的方法,对在我院急诊就诊的精神病患者的性别、年龄、患病日期、文化程度、职业、婚姻状况、就诊方式、首次诊断的方式、去向等多个项目进行调查统计分析。结果：实际发放2386份调查问卷,共收到2315例调查反馈表,占全年急诊精神病患者的97.02%;其中患者男女比例为0.78：1,平均年龄37.46±16.5岁;每年的3月至5月是精神病患者急诊的高峰期;高中、初中及以下文化程度的工人、农民是急诊精神疾病患者的主要群体;心理障碍、酒精和精神分裂是导致急诊精神疾病患者的主要发病种类,占发病种类总数分别为29.5%、19.4%以及37.4%;首次就诊的患者有67.8%选择综合医院,剩下的选择专科医院。结论：本研究为常见的急诊精神疾病患者就诊时的流行病学特征进行统计归纳,对指导急诊专业人士培训有指导意义,同时对加强普及精神病卫生知识,针对不同的发病特诊采取针对性预防和治疗措施,减缓疾病的进一步发展。     

Seasonal depressive disorder: a controlled study in Tunisian psychiatric sample

Seasonal affective disorder is considered as a clinical subtype of major depression. The criteria for seasonal pattern has been recently described in the international classification of mental disorders. The aim of this study was to compare the clinical characteristics of patients with major depression and with a seasonal and a non seasonal pattern. The study was conducted at the psychiatric ward at Monastir university hospital. 16 inpatients with major depression and seasonal pattern, diagnosed with DSM-IV criteria, were matched in age, sex and diagnostic sub-type to 32 inpatients with non seasonal mood disorders. Clinical symptoms and short term course during the most recent depressive episode were obtained. The onset of the depression with seasonal pattern was frequently in winter. It was marked by significantly higher rates of anxiety. The patients with seasonal depression had significantly higher rates of dysphoria, atypical vegetative symptomatology and lower rates of psychotic characteristics and suicidal thoughts. No differences were found as to the psychiatric family histories or the age at the first depressive episode. This study could focus of the novel psychiatric entity and may lead to the development of the genetic and neurobiologic research related to seasonal affective disorder.     

精神障碍患儿住院临床资料分析

目的:回顾性研究我院精神障碍患儿患病类型及分布特点。方法:对2014年6月—2019年6月期间于我院住院治疗的1280例精神障碍患儿性别、年龄和精神障碍类型等临床资料进行回顾性分析。结果:1280例精神障碍患儿中,单一疾病448人,共病832人,其中共病多为三种精神障碍共病,占总数30.39%;精神障碍发病率总体上4~8岁年龄段>9~13岁年龄段>14~18岁年龄段(P<0.05),其中ASD+焦虑障碍、ASD+焦虑障碍+抑郁障碍、焦虑障碍+抑郁障碍多见于4~8岁年龄段,ADHA+ASD+睡眠障碍、TS+OCD+ADHD多见于9~13岁年龄段,ADHD+OCD多见于14~18岁年龄段,每种疾病类型各年龄段之间差异具有统计学意义(P<0.05)。结论:儿童精神障碍发病趋于低龄化,精神障碍疾病在儿童中多以共病形式存在,各年龄段呈现不同精神障碍类型分布。     

Psychological comorbidity. A challenge in acute care

Comorbid mental disorders are common in patients with chronic conditions. It can be assumed that around 30% of all inpatients have some kind of mental disorder. Most frequent are depressive disorders, anxiety disorders, somatoform disorders, and addictive disorders. Mental disorders are not only a subjective burden for the patient, but may also lead to an unfavourable course of the disease, longer hospital stay, and increased treatment costs. However, despite its importance comorbid mental disorders are often not recognized or appropriately treated. Wherever possible, patients with psychological issues should be presented to a psychosomatic or psychiatric consultation-liaison service for further diagnosis and treatment. To treat patients with comorbid mental disorders, physicians must be well experienced in psychotherapeutic treatment and a collaborative interdisciplinary working environment must have been established.     

某院2015年-2019年罕见病住院病例特征分析

目的分析陕西省某三甲综合医院2015年-2019年罕见病住院病例特征，为开展罕见病研究提供依据。方法根据《第一批罕见病目录》，收集医院2015年-2019年罕见病住院病例资料，进行回顾性分析。结果2015年-2019年医院共收住院罕见病患者1 055例次，占住院患者总例数的0.15%。罕见病病例数男女性别比为1.14:1；不同年龄段病例数分布依次为中年组＞青年组＞老年组＞儿童组；涉及21个疾病系统分类中的10个分类，其中神经系统疾病患者最多；共覆盖42种罕见病，前10位病种人数占患者总数的84.55%，前3位分别为肌萎缩侧索硬化、视神经脊髓炎、重症肌无力；从费用构成来看，前10位病种诊断费及药品费占比普遍较高，少数病种耗材费占比较高。重复住院率前10位的病种中，重复住院率在25%～64%。结论该院罕见病发病年龄跨度大、疾病类型多样、住院费用较高、个体差异较大，具有一定代表性，可为推动陕西省乃至西北地区罕见病研究提供参考。     

Psychiatric disorders in elderly patients admitted in a general hospital]

STUDY OBJECTIVE. To determine the prevalence of psychiatric disorders, especially depressive illness, in elderly medical inpatients. SETTING. University Hospital Leiden. DESIGN. Two-stage design. PATIENTS AND METHODS. In six somatic wards a series of 250 patients were randomly selected and screened with two self-rating scales for depression (Beck Depression Inventory, Geriatric Depression Scale) and one screening scale for cognitive dysfunctions (Mini-Mental State Examination). The 52 drop-outs differed significantly from the other patients only in a greater general illness severity, and a higher prevalence of a psychiatric history. Eighty-two patients were selected for a diagnostic procedure with a standardised, semi-structured psychiatric interview, and were classified according to the DSM III-R. Fifty-nine of them were probable cases according to the screening instruments, 23 were selected at random from the probable non-cases. RESULTS. A psychiatric disorder was detected in 25 patients, all but one patient with schizophrenia were found in the group of probable cases. Only five patients were classified as major depression, which lead to a prevalence rate of 2.9% (95% CI 0.4-5.4%). We found evidence of many psychiatric disorders in the group of 52 drop-outs, but these were mostly organic psychiatric disorders, and just one mood disorder. CONCLUSION. The prevalence of major depression is lower than found until now among elderly medical inpatients.     

Depressive disorder and depression within schizophrenia spectrum disorders: are they the same?

Depressive states are a prevalent condition in mental disorders other than depressive disorders, which raises the question of whether or not depression in non-depressive disorders and depressive disorders has the same clinical and biological meaning. The aim of this study was to test the hypothesis that depression in schizophrenia spectrum disorders and depressive disorders does have the same characteristics regarding gender distribution and family history of mood disorders in first-degree relatives. The study sample was made up of 660 psychotic patients who were assessed for alternative definitions of depressive states. The pattern of gender distribution and family antecedents of mood disorders in those patients having depressive symptoms or syndromes was very similar to that reported in depressive disorders, and more specifically to depression in patients with schizophrenia spectrum disorders. These data support the hypothesis that depressions in schizophrenia spectrum disorders do have the same biological meaning as in depressive disorders.     

585例恶性肿瘤病人死亡原因分析

目的通过该院2003—2011年住院病人恶性肿瘤死亡的疾病构成、年龄分布、性别比例的统计分析,为恶性肿瘤的防治工作提供科学依据。方法在该院2003—2011年住院病人病案首页中,按照《国际疾病分类》ICD-10编码选取因恶性肿瘤疾病导致死亡的患者585例,计算恶性肿瘤死亡疾病构成、年龄分布、性别比例。结果按疾病顺位,前十位恶性肿瘤死亡疾病依次是肺恶性肿瘤、肝恶性肿瘤、白血病,结肠恶性肿瘤、胃恶性肿瘤及食管恶性肿瘤、直肠恶性肿瘤、胰腺恶性肿瘤、脑恶性肿瘤及恶性淋巴瘤。同时对年龄分布、性别比例进行统计分析,发现在本组585例恶性肿瘤病人死亡高发段在60~79岁,共308例,占52.65%,而且因恶性肿瘤疾病死亡的男性患者多于女性,性别比为1.80:1。结论定期体检,做到早发现、早诊断、早治疗,以降低恶性肿瘤的病死率,提高人群的期望寿命。     

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 Northern Finland general population birth cohort

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982–1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77.0%) vs 6687 out of 10 630 (62.9%) (OR = 2.0, 95% CI = 1.6−2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7−99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5–38.1) and schizophrenics more than a 30-fold risk (OR = 37.5, 95% CI = 19.1–73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2–4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2–4.2), vertebral column disorders (OR = 4.2, 95% CI = 1.8–9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2–3.6) and induced abortions (OR = 1.8, 95% CI = 1.2–2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0–31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1–5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8–42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable physical morbidity in their patients.