福建省本级参保人员恶性肿瘤患病及医疗费用分析

[目的]探讨参保人员肿瘤患病及住院医疗费用。[方法]对参保人员恶性肿瘤患病情况进行描述性研究，比较分析恶性肿瘤患者住院医疗费用及对医保基金的影响，用多元逐步回归探讨肿瘤患者住院费用的影响因素。[结果]福建省本级参保人员恶性肿瘤患病率为556.2/10万。前4位恶性肿瘤为肝癌、胃癌、肺癌和乳腺癌。恶性肿瘤患者年人均住院医疗费用为58077.77元，人均住院64.4天，恶性肿瘤患者住院总医疗费用占所有参保住院患者总医疗费用的比例为33.3%。住院总费用与住院次数、天数、手术和性别相关。[结论]恶性肿瘤患者医疗费用对医保基金影响较大，要控制恶性肿瘤的发病，缩短无效住院日，降低肿瘤住院患者的医疗费用。     

住院肿瘤病人医疗服务利用与经济负担分析

[目的]分析住院肿瘤病人的医疗服务利用、费用情况,为加强医疗服务管理和费用评价和控制,减轻病人负担,提高医疗工作效率提供可靠依据。[方法]通过医院信息系统(HIS)抽取某三级甲等肿瘤专科医院2010年全部出院病人的医疗服务利用和费用数据,对病人基本信息、医疗服务项目应用及其收费情况进行分析。[结果]2010年全院共有出院病例10 554例,出院22 932人次;共诊治疾病574种,利用医疗服务项目4 565种,每例平均出院2.2次,平均住院日14.6天/人次,平均医药费用20 927.22元/人次。[结论]肿瘤专科医院各科室住院病人和各病种住院病人的医疗服务利用与费用具有差异,对住院肿瘤病人的医疗服务利用与收费评价和控制,应针对各科室、各病种和各个医疗环节分别进行。     

2236例超长住院患者住院时间的影响因素分析

[目的]了解超长住院日形成原因,为医疗管理部门有效缩短平均住院日提供参考依据.[方法]收集2015年1月1日至2015年6月30日医疗统计系统资料,对超长住院患者(住院时间≥30天)进行统计分析.[结果]超长住院患者主要集中在40～59岁(52.99％)和60～79岁(36.23％),主要病种是肺恶性肿瘤(18.16％)、乳腺恶性肿瘤(18.11％)和宫颈恶性肿瘤(16.19％).治疗方式是影响超长住院时间的独立危险因素.[结论]规范诊疗行为、优化住院诊疗和服务流程、加强围手术期管理是减少住院时间的重要途径.     

873例次天津市儿童肿瘤住院患者医保支付费用分析

摘 要：［目的］ 对住院儿童肿瘤患者进行医保支付费用的分析,为医院加强控费管理和儿童大病患者医保政策的优化提供依据。［方法］ 以天津市肿瘤医院儿童肿瘤科2014至2018年诊断为恶性肿瘤的873例次住院医保患者为研究对象,利用SPSS 19.0统计软件,分析患者基本情况、病种构成、诊治特点与住院费用、医保支付费用的关系。［结果］ 873例次儿童肿瘤患者男童多于女童。恶性淋巴瘤、肾母细胞瘤、横纹肌肉瘤为前3位诊治病种,占51.77%。手术治疗和内科治疗为主要治疗方式。平均住院日、次均发生费用和次均医保支付费用均呈下降趋势。住院费用构成中药品费所占比例最高,在30%以上。医保报销后患者个人负担仍较大。［结论］ 儿童肿瘤治疗周期较长,关键有效治疗手段的医保支付比例偏低,致使总体医保费用支持不足,患者家庭负担较重。提高儿童肿瘤患者治疗的医保支付比例、扩大儿童恶性肿瘤支付项目的限定范围或引入商业保险作为补充是将来发展的主要方向。     

2002~2014年1542例肺癌患者住院费用分析

[目的]探讨肺癌患者住院费用的变化和影响因素,为肺癌患者住院费用合理控制提供理论依据.[方法]选取2002～2014年湖南省某三级甲等专科医院收治的1542例肺癌患者为研究对象,采用方差分析和多元逐步回归分析对其多次住院总费用影响因素进行分析.[结果] 1542例肺癌患者平均就诊年龄56.49±9.7岁,平均住院天数33d,人均住院费用34 300.0元,且2002～2014年总体呈上升趋势;住院费用构成中,药品费占比最大,达56.6％,其次是材料费、检查费和治疗费,其占比分别是9.7％、8.4％和8.1％.住院费用的影响因素依次为:是否手术、住院次数、住院天数、伴随疾病否、就诊年龄、是否腺癌和是否放疗,多元回归模型中均有统计学意义(F=301.40,P＜0.05).[结论]2002～2014年间肺癌患者住院费用总体呈上升趋势,建议医院针对费用影响因素,加强对药物科学合理使用、缩短住院天数及进一步提高医务工作者的医疗水平,以有效控制肺癌患者医疗费用的增长,减轻其医疗负担.     

肿瘤医院电子化临床路径管理系统实施效果评价

[目的]探讨电子化临床路径管理系统对医院管理的影响.[方法]以肿瘤医院2013～2014年4个住院病种(肺癌,食管癌,乳腺癌,甲状腺癌)为研究对象,出院时间为2014年的病例纳入研究组,出院时间为2013年的病例纳入对照组,分析两组住院患者平均住院日和平均住院费用的差异.[结果]研究组平均住院日和平均住院费用均低于对照组,其中食管癌、乳腺癌和甲状腺癌平均住院日研究组明显短于对照组(P＜0.05);肺癌和食管癌平均住院费用研究组较对照组显著降低(P＜0.05).[结论]电子化临床路径管理系统可以有效缩短患者住院天数,对于住院费用的上涨有间接的控制作用.     

肺癌化疗患者临床路径实施效果分析

[目的]分析评价肺癌化疗患者临床路径实施效果.[方法]采用同期对照法,选取2013年1月1日至2013年12月31日在辽宁省肿瘤医院住院的254例肺癌化疗患者为研究对象,其巾符合肺癌化疗临床路径纳入标准的201例患者为临床路径组,其他53例患者为非临床路径组.对比分析两组患者的平均住院日、费用构成比,分析肺癌化疗患者的入径率、入径完成率.[结果]临床路径组平均住院日小于非临床路径组,约有56％的患者平均住院日达到标准住院日要求,临床路径组平均住院费用小于非临床路径组.肺癌化疗患者临床路径入径率79.13％,入径完成率89.1％.[结论]肺癌化疗患者临床路径管理可以有效缩短住院日、在一定程度上控制了住院费用的增长.     

临床路径管理在乳腺癌住院患者中的应用效果

[目的]探讨临床路径管理在控制乳腺癌患者住院费用及住院天数等方面的效果。[方法]采用回顾性比较临床路径实施前后乳腺癌住院患者的相关情况,主要评价指标包括住院费用、住院天数、医疗质量等。[结果]两组患者的治疗效果、住院病死率、临床与病理诊断符合率、入院与出院诊断符合率之间差异无统计学意义（P〉0.05）,而临床路径组患者的住院并发症发生率明显低于对照组（8.4%vs 14.7%,χ2=4.768,P=0.009）。临床路径组的平均住院总费用、药费、治疗费、材料费均少于对照组;临床路径组平均住院总天数和术后住院天数均少于对照组（P〈0.05）。临床路径组乳腺癌患者住院费用构成前3位依次为药费（57.2%）、检查费（17.8%）和手术费（9.1%）,共占住院总费用的82.7%;对照组患者住院费用构成前3位依次为药费（58.7%）、治疗费（15.0%）和手术费（8.7%）,共占住院总费用的82.4%。[结论]乳腺癌临床路径管理可以缩短平均住院日、降低住院费用和提高诊疗质量,值得进一步推广。     

2003～2012年辽宁省肿瘤医院恶性肿瘤住院患者病种及年龄分析

[目的]分析辽宁省肿瘤医院首次住院的恶性肿瘤患者病种构成及年龄构成,为开展肿瘤防治工作提供参考依据。[方法]对2003～2012年首次住院的89319例恶性肿瘤患者病案资料进行统计分析。运用Excel及SPSS13.0统计软件进行数据处理。[结果]前10位恶性肿瘤依次为肺癌、乳腺癌、结直肠癌、子宫癌、胃癌、食管癌、肝癌、卵巢癌、膀胱癌、甲状腺癌,占10年来恶性肿瘤总例数的81.17%。其中肺癌构成比居男性恶性肿瘤第1位,占男性恶性肿瘤的26.79%。乳腺癌构成比居女性恶性肿瘤第1位,占女性恶性肿瘤的30.71%。肿瘤发病年龄相对集中,高发于40岁以上的中老年人群。[结论]肿瘤发病存在年龄、性别差异,应针对高危人群做好癌症的三级预防工作。     

恶性肿瘤住院费用的影响因素分析

住院费用是每个住院患者与家属以及社会比较敏感的问题之一。医药费的单价增加,昂贵药品的不断出现,一些高精密检查项目的应用,一次性消耗品的广泛使用,还有医院本身经济导向的刺激因素等致使住院患者的费用有不断上升的趋势。现将我院1997年收治的肿瘤病人住院费用情况作一分析。1一般情况我院1997年1月至门月间出院的143例恶性肿瘤患者的平均住院日为sl．5日,平均日住院费用为118．9元,每人平均总费用为6120．l元。住院费用构成比中,药费占62．4％,治疗费（手术、操作、注射、输氧、放疗、介入等）占10.9％,检查是（CT、X光、…     

新疆某三甲肿瘤医院乳腺癌患者住院费用及影响因素分析

目的:了解乳腺癌患者住院费用情况及主要影响因素。方法:采用回顾性调查分析方法,以乳腺癌住院患者为主要研究对象,收集乳腺癌患者的一般情况、平均住院天数、住院次数、住院费用等信息。对研究对象的基本特征及住院费用构成进行描述性分析,采用单因素方差分析、多重线性回归对可能影响住院费用的因素进行分析。结果:乳腺癌患者的平均年龄为（49.76±12.12）岁,41-60岁年龄组病人最多,占59％。住院费用构成中,药品费占总费用的比例最高,为65%,其次为治疗费（14%)和检查费(7%)。采用单因素方差分析,结果表明年龄、住院次数、平均住院天数、治疗方案与患者的住院费用密切相关,有统计学差异（P＜0.05）。将这些因素采用多重线性回归分析,结果表明住院次数、平均住院天数与住院费用密切相关,有统计学差异（P＜0.05）。结论:合理缩短住院天数,减少药品费用是控制乳腺癌病人住院费用的有效途径。发展乳腺癌早期筛查,早发现早治疗,减少不必要的检查,可降低住院费用。     

Analysis on Characteristics and Nursing Points of Surgical and Interventional Treatment for Elderly Cerebral Aneurysm

Objective. The purpose was to explore the characteristics and nursing points of surgical and interventional treatment for elderly cerebral aneurysm. Methods. 100 elderly patients with cerebral aneurysm treated in our hospital from January 2017 to December 2019 were selected, and divided into craniotomy group (40 patients with neurosurgical clipping) and interventional surgery group (60 patients with endovascular interventional embolization) according to the treatment method to compare the operation time, hospitalization time, hospitalization expenses, degree of brain injury, complications and prognostic scores of the patients in two groups. Meanwhile, the relationship between the factors (age, aneurysm size, location) and prognosis of patients was analyzed, and the nursing points were summarized. Results. (1) The operation time and hospitalization time of the interventional surgery group were lower than those of the craniotomy group, but the hospitalization expenses were higher than those of the craniotomy group (P = 0.000). (2) The brain injury indexes of the two groups at 6h and 24h after operation were higher than those before operation, and the indexes of the craniotomy group were higher than those of the interventional surgery group (P = 0.00). (3) The overall complication rate was 16.67% in the interventional surgery group, which was lower than 37.50% in the craniotomy group (P = 0.005). (4) The good recovery rate of GCS score in interventional surgery group was 63.33%, which was higher than 42.50% in craniotomy group (P = 0.040). (5) Univariate analysis. The aneurysm location, preoperative Hunt-Hess grade and combined hyperlipidemia were related to the prognosis of patients (P < 0.05). (6) Multivariate analysis. The aneurysm location and preoperative Hunt-Hess grade were independent factors affecting the prognosis of patients (P < 0.05). Conclusion. Interventional surgery for elderly cerebral aneurysm is superior to craniotomy in reducing surgical trauma and accelerating postoperative recovery, but the hospitalization expenses are higher than those of craniotomy. Aneurysm location and preoperative Hunt-Hess grade were independent factors influencing the prognosis of patients. Postoperative nursing for elderly cerebral aneurysm should start from basic nursing, psychological nursing and symptomatic nursing.     

胃癌术后患者早期肠内营养支持的临床价值

目的：探讨胃癌术后早期肠内营养支持的时机、安全性、可行性。方法：将51例胃癌胃大部切除手术患者随机分为肠内营养组（EN组,n=26）和肠外营养组（PN组,n=25）。肠内营养组（EN组）采用术中放置十二指肠营养管及胃肠减压管,术后12小时开始进行肠内营养。肠外营养组（PN组）采用术中仅放置胃肠减压管,术后常规＂三升袋＂静脉高营养。两组分别监测术后第1天、第10天患者的血清白蛋白、血清前白蛋白、血红蛋白、免疫球蛋白（A、G、M）、白细胞总数、早期胃肠道恢复时间、住院时间及平均住院费用等指标。结果：EN组术后血清白蛋白、血清前白蛋白、免疫球蛋白G水平较PN组恢复迅速,两者间有显著差异（P〈0.05）。EN组术后肛门排气排便时间较PN组缩短。EN组在缩短术后住院时间与减少住院费用方面也较PN组具有优势,差异显著（P〈0.01）。结论：胃癌术后早期肠内营养支持在时机上是安全、恰当、可行的,对改善术后早期机体营养状态具有显著作用,同时明显促进胃肠功能恢复,减少了患者住院时间与费用。     

The Dilemma of Prostate Cancer: A Growing Human and Economic Burden Irrespective of Treatment Strategies

All prostate cancer patients (719 patients) within a specified population were studied in order to assess both the overall economic burden of this disease to the health-care economy and its burden to the individual patient. The economic burden was estimated as the total lifetime expense (1995 prices) of all palliative hospital treatment. The expenses associated with prostate cancer therapy averaged US$ 19 755 per person. By extrapolation, palliative therapy for this disease currently consumes almost 1% of the entire Danish health-care budget. A total of 62% of the patients died from the disease. During hospitalization these patients on average required three times as much hospital care as other patients and about one-third needed regular treatment with opiates or equivalent drugs. Under the present circumstances we cannot recommend an aggressive strategy towards localized prostate cancer even though the incidence of this disease is increasing at an alarming speed and its economic and human costs are excessive.     

系统营养干预在胃癌化疗患者中的应用

目的:观察系统营养干预在胃癌化疗患者中的临床疗效。方法:将本组60例患者随机分为2组,分别为营养干预组（治疗组）30例,对照组30例。对治疗组30例患者进行系统的营养干预,观察两组患者在治疗前后SGA营养评定结果和体重、体重指数（BMI）、血红蛋白（HGB）、血清白蛋白(ALB)、血清前白蛋白(PA)和淋巴细胞(LYM)总数的化验结果,生活质量及患者的住院时间、住院费用。结果:治疗后治疗组SGA营养状况优于对照组;治疗后治疗组体重、BMI、血红蛋白、血清白蛋白、血清前白蛋白和淋巴细胞总数及生活质量均优于对照组;治疗后治疗组住院费用和住院时间均少于对照组。结论:系统营养干预能提高患者生活质量,缩短住院时间,减少住院费用,值得在临床推广。     

高级别上皮内瘤变及早期胃癌内镜与外科治疗在随访及经济指标中评估研究

目的探讨内镜与外科手术治疗高级别上皮内瘤变及早期胃癌术后残胃及吻合口黏膜改变、费用及治疗时间、随访复发情况。方法收集25例内镜治疗及100例外科手术治疗患者,分别从术后黏膜改变状态(充血、糜烂、溃疡、伴随胆汁反流)、治疗费用与时间、术后随访复发情况3方面评估,利用SPSS 16.0统计软件进行统计。结果外科手术术后黏膜明显充血者87.0%,糜烂36.0%,溃疡9.0%,伴随胆汁反流高达48.0%,内镜组除手术瘢痕外无明显术后黏膜炎性改变(P<0.001);外科手术组平均花费为(3.56±1.12)万元,平均住院时间(20±9)天,内镜治疗组平均费用(0.57±0.42)万元,平均治疗时间(5±2)天(P<0.001);外科组随访中见1例复发,内镜治疗组无复发(P>0.05)。结论内镜切除治疗高级别上皮内瘤变不仅能显著改善术后黏膜状态、降低治疗费用、缩短恢复时间,而且具有与外科手术类似良好预后。     

Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms

Endovascular techniques for the treatment of intracranial aneurysms have gained rapid acceptance in some countries as an alternative to conventional neurosurgical treatment. The International Subarachnoid Aneurysm Trial (ISAT) is the first multicentre prospective randomized trial comparing neurosurgery with endovascular coil (Guglielmi detachable coil) treatment of acute subarachnoid haemorrhage. The cost and outcome of endovascular procedures was compared with neurosurgical procedures in the treatment of ruptured intracranial aneurysms within the context of the ISAT. Two groups of patients (Endovascular group with 10 patients and the Neurosurgical group with 12 patients) were drawn from admissions to Royal Perth Hospital and Sir Charles Gairdner Hospital, Perth, Western Australia, as detailed in the ISAT trial protocol. Data were collected in the following categories: patient, procedure, hospitalization, morbidity and mortality. While the endovascular procedure tended to be the more expensive in terms of the cost of consumables, this expense was more than compensated by savings in staffing costs, and the period and cost of hospitalization. Following an endovascular procedure, patients tended to return to normal activity or paid employment sooner and have a favourable functional outcome compared with patients following a neurosurgical procedure.     

不同治疗方法对前列腺癌合并房颤的影响 及预防策略研究进展

心房颤动(AF)是临床上最常见的心律失常。随着人口老龄化,发病率呈逐年上升趋势。AF风险增加的相关危险因素包括老年、肥胖、糖尿病、高血压和癌症等。研究表明,在所有年龄组中,伴发AF癌症患者的死亡率、住院费用和住院时间均高于非AF患者。前列腺癌(PCa)患者全身炎性反应增加、电解质异常和神经激素变化,导致其AF发生率明显高于其他癌症。前列腺癌手术、化疗和放疗也可能增加AF的风险。本综述系统收集相关文献,了解PCa患者发生AF的机制,确定PCa与AF之间的关系及其对住院预后的影响,为防治PCa患者发生AF提供策略。     

The Economic Burden of Breast Cancer Survivors in Korea: A Descriptive Study Using a 26-Month Micro-Costing Cohort Approach

Background: This study analyzed the burden of cancer treatment costs on patients by calculating the monthlyamount of medical expenses paid by breast cancer patients for two years after mastectomy. Methods: Among thosewho were diagnosed with breast cancer and had received treatment at one of two academic medical centers in Seoulbetween 2003 and 2011, 1,087 patients who underwent mastectomy and received follow-up for at least two yearswere recruited. A micro-costing approach from the provider’s perspective, based on a retrospective review of patientmedical claim records, was used to analyze cancer treatment cost of care. The cohort’s number of hospitalizations,total hospitalization duration, and number of outpatient visits were noted, and the total amount of medical expenses,out-of-pocket (OOP) expenditures, uninsured costs, and OOP ratio were calculated. Results: The total amount ofmedical expenses tended to increase by year, whereas the OOP expenditure ratio decreased. The OOP expenditureratio was highest in the first month post-operation. Around one quarter of the total OOP payments incurred over thecourse of three months: one month before the operation, the month of the operation, and one month post-operation.Conclusion: OOP payment burden on patients was concentrated in the initial phase of treatment, and items not coveredby the National Health Insurance caused an additional increase in patients’ burden in the initial phase. The economicburden of cancer treatment varies considerably. In order to alleviate patients’ medical expenses burden, the timing ofexpenditures and the possible financial burden on cancer survivors, they should be understood more fully and possiblyaddressed in interventions aimed at reducing the cancer burden.