2013-2015年保定市三甲医院肺癌患者住院费用分析

目的掌握肺癌患者住院费用的分布及构成情况,为完善医疗保障制度、合理分配医疗资源以及为减轻肺癌患者的经济负担提供参考依据。方法收集2013-2015年保定市三甲医院的肺癌住院患者的住院费用,运用Excel 2003软件和SPSS 22. 0统计软件对数据进行描述性分析。结果 9 939名肺癌患者的人均住院费用为22 025元,其中94. 18%的肺癌患者的住院费用小于3万元,且呈逐年上升趋势;位于肺癌患者住院总费用前三位的分别是药费、治疗费和卫生材料费;药费在肺癌患者住院总费用中的比例过半,甚至达60%以上,且人均药费增长速度较快,2015年达20. 09%;治疗费占住院总费用的10%～15%左右,且三年来人均治疗费呈总体微弱的下降趋势; 2015年人均卫生材料费增长速度过快,达32. 83%。结论 2013-2015年保定市三甲医院肺癌患者的经济负担较重,药费在肺癌患者住院总费用中的比重较大,近年来卫生材料费用增长较快。     

肺炎克雷伯菌与大肠埃希菌所致血流感染患者的临床分布及疾病负担差异比较

目的研究肠杆菌科细菌中肺炎克雷伯菌与大肠埃希菌所致血流感染患者的临床分布特征和疾病经济负担的差异。方法回顾性调查2014年1月-2015年12月医院肺炎克雷伯菌或大肠埃希菌所致血流感染的住院患者436例,分别对其临床科室分布及住院时间、住院费用分析比较。结果共纳入436例患者,其中肺炎克雷伯菌感染患者154例占35.3%,大肠埃希菌感染患者282例占64.7%;最多见的临床科室分布为肝胆外科、重症监护室和肿瘤科,其中肺炎克雷伯菌感染多分布于重症监护室(25.3%)和肝胆外科(22.7%);大肠埃希菌感染多分布于肿瘤科(17.1%)、肝胆外科(16.5%)和消化内科(10.3%);肺炎克雷伯菌血流感染患者的住院时间(P=0.007)及住院费用(P<0.001)均显著高于大肠埃希菌血流感染患者;住院时间和住院费用由高到低的科室依次为重症监护室、血液科、肝胆外科、肿瘤科等。结论肺炎克雷伯菌和大肠埃希菌所致血流感染患者在医院分布广泛,且两种细菌血流感染的临床科室分布存在差异,肺炎克雷伯菌所致血流感染患者的住院时间更长、住院费用更高,临床工作中应该对肝胆外科、重症监护室及肿瘤科等高危科室进行重点监控,以更有效地控制相关感染。     

皮肤病专科医院高额住院费用影响因素的结构方程模型验证研究

目的 探究皮肤病专科医院高额住院费用的影响因素,为减轻患者医疗负担、优化医疗费用结构提供参考。方法 以2015—2019年广东省某大型三级甲等皮肤病专科医院高额住院费用患者的住院数据为例,运用差异性统计、结构方程模型分析高额住院费用的影响因素。结果 年龄(β=-0.072,P<0.001)、是否手术(β=0.157,P=0.001)、是否院感(β=0.043,P=0.030)、是否月内再入院(β=0.040,P=0.011)、是否使用抗菌药物(β=0.155,P<0.001)、住院天数(β=0.304,P<0.001)直接作用于住院费用,年龄(β=0.028,P<0.001)、婚姻状况(β=0.021,P<0.001)、是否合并症(β=0.026,P<0.001)、是否院感(β=0.017,P<0.001)、是否使用抗菌药物(β=0.089,P<0.001)、是否临床路径(β=0.001,P=0.001)通过作用于住院天数间接影响住院费用,且住院天数对皮肤病患者高额住院费用的影响最大(β=0.304,P<0.001)。结论 缩短住院...     

江苏省三级乙等医院肺结核患者住院费用分析

目的分析某院2013-2015年肺结核患者住院费用,探讨其影响因素,为减轻肺结核患者经济负担提供参考。方法收集该院2013年10月-2015年12月间首要诊断为肺结核的住院患者的病案首页共543份,对其进行回顾性分析。结果该院2013-2015年肺结核患者住院费用的平均水平为6 420.61元,其中药品类费用占59.32%,诊断类费用占24.86%。相关性分析结果表明,住院天数与住院费用呈正相关,年龄因素与住院费用不相关。非参数检验结果显示不同痰镜检结果、合并疾病、出院情况以及付费方式的患者,其住院费用不同。多因素分析结果显示,在控制其他因素的情况下,不同出院情况的人群住院费用之间的差异无统计学意义。结论该院肺结核患者的住院费用低于同期其他地区医院,药品类费用所占比例较高,住院天数、痰镜检结果、合并疾病、付费方式等因素为肺结核患者住院费用的主要影响因素。建议医院对结核病种实施临床路径管理,减少无效住院天数,控制住院费用;同时注重防治合并疾病,做好预防保健工作。     

精神活性物质所致精神障碍的护理体会

目的:探讨精神活性物质所致精神障碍患者的护理体会。方法:研究对象为2010年11月至2012年11月我院精神科收治的102例精神活性物质所致精神障碍患者,随机分为对照组及观察组,每组51例,对照组实施常规护理方法,观察组实施整体护理干预。结果:观察组在生理、心理及日常生活能力方面的指标均显著改善,优于对照组(P<0.05)。结论:开展有效护理干预有助于改善精神活性物质所致精神障碍患者的生理、心理素质,提高其社会活动能力,值得推广应用。     

2015—2019年山西省糖尿病住院病例统计及住院费用影响因素分析

目的 了解山西省糖尿病患者住院状况及疾病流行特征,探讨住院费用的影响因素,为加强住院费用的控制管理和患者的健康管理提供依据。方法 收集样本地区2015—2019年77 933例糖尿病患者住院情况,使用结构方程模型分析住院费用的影响因素。结果 糖尿病患者住院人次逐年增加,男性增长率高于女性;60～69岁的患者最多,发病年龄发生后移;平均住院天数为10.64天,住院天数呈缩短态势;手术患者、并发症患者不断增加;市、区、县级机构就诊患者总体呈上升趋势,就诊机构级别发生下移。平均住院费用为7 855.95元,检查费(36.01%)、药品费(35.68%)占比较大。平均住院费用、药品费、床位费呈下降趋势;治疗费、其他费波动上升;检查费呈下降趋势(趋势检验P值均<0.001)。结构方程模型结果显示影响住院费用的因素由大到小为住院天数、性别、机构级别、有无并发症、是否手术、年龄。结论 我国糖尿病管理取得了一些成绩,但疾病负担仍较严重,应加强对检查费和药品费的监管、缩短住院天数、以基层为依托,开展高危人群健康教育和筛查,加强糖尿病预防工作。     

基于卫生费用核算的我国慢性病可避免住院费用分析

目的:核算分析2016年我国慢性病非传染性疾病(以下简称慢性病)可避免住院费用规模及结构,为提高我国医疗卫生资源利用效率提供政策依据。方法:以卫生费用核算为基础按照可避免住院疾病范围,核算分析我国慢性病可避免住院费用总量和构成。结果:2016年我国慢性病可避免住院费用总量为1 492.63亿元,占到总住院费用的10.45%。从机构分布看,65%的慢性病可避免住院费用主要发生在区县级医院;从疾病分布看,73%的可避免住院费用发生在慢性阻塞性肺病、糖尿病、高血压;从人群分布看,50岁及以上人群是可避免费用的消费主体。结论:我国可避免住院费用规模较大,反映出我国可避免住院问题比较严重,应加大对重点疾病、重点人群干预作用;探索建立我国可避免住院监测指标体系,为构建以医疗价值和健康为中心的医疗卫生服务体系提供信息支持。     

广西某三甲医院2017—2019年2型糖尿病患者住院费用分析

目的 通过对广西某三甲医院2型糖尿病患者住院费用的构成和主要影响因素进行分析,为控制住院费用增长、减轻疾病经济负担、合理配置卫生资源提供参考。方法 收集广西某三甲医院2017—2019年2 325例2型糖尿病患者的住院费用资料,按照性别、年度、年龄、住院天数、报销类别及亚型分组进行描述性统计及方差分析。结果 住院患者和费用整体呈增加趋势,费用增长幅度为28.07%。诊查费占比逐年增加,由53.92%增长至54.38%,药品费稳定占比30%左右。50～60岁年龄段例数最多且费用最高,住院天数越多,费用也越高。外埠医保病人的费用要高于本地医保组、自费组及其他组,不同报销类别之间费用具有差异性(F=7.746,P<0.001)。不同诊断亚目之间费用具有差异性(F=8.431,P<0.001)。结论 2型糖尿病患者的住院费用与构成不合理、年龄、住院天数、报销类别及并发症类别等因素有关。应不断优化住院费用结构,规范临床路径,缩短住院时间,加强医保异地就医管理,提高全民预防意识,有效控制住院费用,合理分配医疗资源、降低疾病经济负担。     

精神活性物质所致精神障碍患者的护理

目的探讨精神活性物质所致精神障碍的临床特点及护理对策。方法对50例精神活性物质所致精神障碍患者的临床资料进行回顾性分析。结果精神活性物质所致精神障碍患者以青壮年男性、无业人员居多;精神症状以幻觉妄想、情绪障碍、冲动为主。结论经系统治疗护理后,精神活性物质所致精神障碍的症状得到缓解,但出院后复用精神活性物质复发病再住院发生率亦高,这类患者需要家庭社会共同参与的长效机制才能有较好的效果。     

1 381例结直肠癌患者住院费用分析

目的 探讨结直肠癌患者住院费用的变化及其影响因素,为控制住院费用的不合理增长及结直肠癌的防治提供参考依据.方法 选取2006-2011年山西省某三级甲等综合医院收治的1 381例结直肠癌患者为研究对象,采用方差分析和多元逐步回归分析法对其住院费用的影响因素进行分析.结果 1 381例结直肠癌患者平均住院天数为19 d(中位数),平均年龄为(59.66±12.18)岁,人均住院费用为19 267.92元(中位数),且呈逐年增长趋势;其中64.88％的住院患者为农民;住院费用构成中,药品费所占的比例最大(33.61％);影响住院费用的主要因素依次为:住院天数、手术与否、住院年份、药占比等;实施手术患者的住院费用高于无手术患者(P＜0.001).结论 6年间结直肠癌患者住院费用呈逐年上升趋势,支付方式发生变化;应不断提高诊疗水平,制定合理的单病种管理措施,控制住院费用不合理增长,减少患者的疾病负担.     

2003—2015年北京市精神疾病住院病人医疗服务基本状况分析

目的：本研究通过对2003-2015年北京市精神疾病住院病人医疗服务基本状况进行分析,为合理配置精神卫生资源和有效使用医疗费用提供数据依据。方法：本研究采用描述性统计方法分析精神疾病住院病人的出院人次、平均住院日和住院费用情况。结果：2003-2015年北京市精神疾病住院病人出院人次逐年增多,从2003年的7861人次,增加到2015年的24898人次,年平均增长速度为10.08%。2011年以来的平均住院日较低,均在40天左右。日均费用逐年增长,从2003年 131.04元增加到2015年的461.02元,年平均增长速度为11.05%。结论：精神疾病患者住院需求逐渐增大,医疗费用快速增长,亟需调整付费政策以促进医疗费用的合理有效使用。     

Infectious disease: #83 Low-risk community acquired pneumonia: Sociodemographic and clinical determinants for hospitalization

PURPOSE: To elucidate socio-demographic and clinical determinants for hospitalization among “low-risk” community acquired pneumonia (CAP) patients. “Low-risk” patients are HIV negative, non-nursing home residents with no major renal, neoplastic or hepatic diseases, and with a Pneumonia Severity Index (PSI) less than 90.METHODS: A retrospective analysis was conducted of 296 low-risk community acquired pneumonia patients examined from January 1999 to January 2000. All patients were assigned a PSI score. 208 (70%) of patients were discharged from the emergency room while 80 (30%) were hospitalized. All patients were assigned to classes I-V according to PSI score. A comparison was made between PSI class II patients discharged from the emergency department and those hospitalized.RESULTS: Predictors for hospitalization were female gender (p < 0.01), African American race (p < 0.05), having medical insurance coverage (p < 0.001), elevated temperature (p < 0.001), and tachycardia (p < 0.001). No statistically significant differences were observed for altered mental status, hypotension, tachypnea, laboratory, and radiologic parameters, and social indicators (e.g., substance abuse).CONCLUSION: Socio-demographic parameters, including age, gender and insurance coverage, are important determinants for hospitalization among “low-risk” patients with community-acquired pneumonia. Clinical predictors for hospitalization were high fever, and tachycardia. The average length of stay for in-patient care was 3.5 days (Range = 3 to 5 days), at ten times higher the cost of out-patient care. This study supports the recommendation of using the PSI for ED evaluation of patients.     

Psychoactive substances and the political ecology of mental distress

The goal of this paper is to both understand and depathologize clinically significant mental distress related to criminalized contact with psychoactive biotic substances by employing a framework known as critical political ecology of health and disease from the subdiscipline of medical geography. The political ecology of disease framework joins disease ecology with the power-calculus of political economy and calls for situating health-related phenomena in their broad social and economic context, demonstrating how large-scale global processes are at work at the local level, and giving due attention to historical analysis in understanding the relevant human-environment relations. Critical approaches to the political ecology of health and disease have the potential to incorporate ever-broadening social, political, economic, and cultural factors to challenge traditional causes, definitions, and sociomedical understandings of disease. Inspired by the patient-centered medical diagnosis critiques in medical geography, this paper will use a critical political ecology of disease approach to challenge certain prevailing sociomedical interpretations of disease, or more specifically, mental disorder, found in the field of substance abuse diagnostics and the related American punitive public policy regimes of substance abuse prevention and control, with regards to the use of biotic substances. It will do this by first critically interrogating the concept of "substances" and grounding them in an ecological context, reviewing the history of both the development of modern substance control laws and modern substance abuse diagnostics, and understanding the biogeographic dimensions of such approaches. It closes with proposing a non-criminalizing public health approach for regulating human close contact with psychoactive substances using the example of cannabis use.     

Reported comorbidity of mental disorders with substance abuse among psychiatric inpatients in israel

In preparation for shifting of care from psychiatric hospital to the community, the prevalence of substance abuse comorbidity among discharged psychiatric patients was studied. Such patients are not usually treated by substance abuse programs or mental health clinics. Data from the Israeli National Psychiatric Case Registry were analyzed on reported substance abuse among all 53,379 psychiatric discharges during 1989–92. The Registry consists of data that physicians are mandated to report on all patients. The authors found that reported substance abuse comorbidity was 13.2% for males and 3.6% for females. Patients with a diagnosis of personality disorder had the most reported substance abuse. Reported drug abuse for males increased with age unitl age 45, and alcohol abuse until age 65. Drug and alcohol abuse by females is the highest for the patients under age 24 and declines with an increase in age. The results were almost identical for each of the four years studied. The results suggest that developing special outpatient facilities to serve this group will be impractical because of the small numbers. Ways of serving these patients in existing community mental health centers are discussed.     

Primary and secondary substance misusers: do they differ in substance-induced and substance-independent mental disorders?

AIMS: This study evaluated the primary/secondary distinction among substance misusers according to comorbid mental disorders. METHODS: A consecutive sample (n = 287) of DSM-IV substance dependents from public treatment facilities in two counties in Norway were assessed by the Composite International Diagnostic Interview. According to the debut of the first independent mental disorder, patients were divided into primary substance use disorder (SUD) (17%), secondary SUD (76%) and SUD in the same year as the first mental disorder (7%). RESULTS: A lifetime substance-independent mental disorder was found in 90%. Forty-two per cent had a combination of substance-independent and substance-induced mental disorders. Five per cent had substance-induced mental disorders only. Primary SUD patients comprised less women, and a lower number of substance-independent mental disorders. Secondary SUD patients had more major depression, phobic disorders and obsessive-compulsive disorder. There were no differences between primary SUD and secondary SUD regarding the number of substance-induced disorders or the pattern of substance misuse. CONCLUSIONS: Clinical differences between primary and secondary SUD were small and do not support the distinction.     

Criminally violent victimisation in schizophrenia spectrum disorders: the relationship to symptoms and substance abuse

ABSTRACT: BACKGROUND: Violent victimisation among people with major mental illness is well-documented but the risk factors for criminal violent victimisation are not well understood. To examine the relationship between symptoms and substance abuse and criminal victimisation in male patients with schizophrenia. METHODS: We examined the relationship between illness-related variables, indices of substance abuse and previous history of violence in a sample of 23 male criminally violently victimized and 69 non-criminally violently victimized male patients with DSM-IV-TR diagnoses of schizophrenia and schizoaffective disorder that were resident in the community and in contact with public mental health services in Victoria Australia. Data on criminal victimisation was acquired from the police database. RESULTS: Demographic, a history of violence or illness-related variables did not distinguish between those had been the victim of a violent crime and those who had not. Our data indicated that drug abuse was a key factor in distinguishing between the groups, but the age of onset of substance abuse was not a significant factor. Scores on measures of drug abuse were modest predictors of criminal victimisation status in our Receiver Operator Characteristic analyses. CONCLUSION: Overall, our findings suggest that substance abuse (particularly drug abuse) is a key predictor of violent victimisation based on criminal statistics. The latter has implications for mental health professions involved in the care planning and community management of patients with major mental illness and work points to the importance of substance abuse treatment in the prevention of victimisation as well as violence perpetration.     

Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study.

OBJECTIVES: This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. METHODS: All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. RESULTS: Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. CONCLUSIONS: This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder.     

Trends in rates of hospitalization with a diagnosis of substance abuse among reproductive-age women, 1998 to 2003.

OBJECTIVE: To describe trends in hospitalizations with a diagnosis of substance abuse among reproductive-age women from 1998-2003. METHODS: Data were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Hospitalizations with a diagnosis of substance abuse were categorized into subgroups by age, primary expected payer, substance-specific diagnoses, concomitance, and hospital location. Trends in hospitalization rates per 100,000 women aged 15-44 were tested using a weighted least-squares method. RESULTS: From 1998-2003, there was no change in the overall rate of hospitalization with a diagnosis of substance abuse among women aged 15-44. Alcohol abuse was the most common substance-specific diagnosis. The rate of hospitalization with a diagnosis of cocaine abuse decreased 22%; for a diagnosis of cannabis abuse, the rate increased 35%. The rate of hospitalization with a diagnosis of amphetamine abuse doubled from 1998-2003. Among women aged 15-24, the rate of hospitalization with a diagnosis of substance abuse increased 23%. CONCLUSION: Although we did not observe a change in the overall rate of substance-abuse hospitalization among reproductive-age women, there were dramatic changes in the rate of substance-specific diagnoses. These data may be used to quantify emerging trends in substance abuse and promote the use of hospital-based interventions.     

Private sector coverage of people with dual diagnoses

In general, people with dual diagnoses account for a significant proportion of both the mental health and substance abuse populations. Most published information on dual diagnosis comes from research on selected treatment programs that are largely funded from public sources. This analysis uses private health insurance claims and eligibility files for 1989 to 1991 for three large firms to identify individuals with both substance abuse and mental health claims and to examine their characteristics, charges, and utilization. More than half of people with dual diagnoses incurred significant charges over three years in both mental health and substance abuse. These individuals with high mental health charges were more likely to be male than were patients with mental health claims alone; they were less likely to be male than were patients with claims for substance abuse and no mental health services. They were also significantly younger than were patients with substance abuse or mental health utilization only for two of the firms. The average charges for people with dual diagnoses were higher than those for patients with substance abuse or mental health claims only.