急诊科服毒自杀患者医疗费用影响因素分析

目的分析大型综合医院急诊科服毒自杀患者医疗费用的影响因素。方法收集2016年1月1日-2018年12月31日湖北省某大型综合医院急诊科服毒自杀患者的一般信息及医疗费用,分别对农药中毒和药物中毒患者的医疗费用进行单因素分析,以筛选可能对其产生影响的因素,通过建立多重线性回归模型确定主要影响因素。结果226例服毒自杀患者中口服农药者共产生医疗费3081681.81元,住院费用中位数(M)为17278.94元,口服过量药物者共产生医疗费用870745.15元,住院费用中位数(M)为11457.17元,选用其他类型毒物者共产生医疗费用133252.03元,住院费用中位数(M)为8221.83元;年龄、住院天数和血液灌流是影响口服农药和口服药物自杀患者医疗费用的共同因素,呼吸机辅助通气是影响口服农药自杀患者医疗费用的特异性因素。结论住院天数是影响费用的主要因素,医院可通过落实双向转诊和知情同意制度、规范血液灌流和呼吸机辅助通气技术的适应症和质量管理、提升基层医疗机构首诊能力等措施控制患者医疗费用,减轻其经济负担。

Factors Analysis of Hospitalization Expenses of Self-poisoning Patients Visiting the Emergengcy Department

Objective To analyze the impact factors of medical expenses of self-poisoning patients visiting the emergency department of a tertiary general hospital.Methods The basic information and medical expenses of attempted self-poisoning patients in the emergency department of a tertiary general hospital from 2016 to 2018 were retrospectively analyzed.Single factor analysis was performed on the medical expenses of patients with pesticide and overdose drugs,and then determine the main ones by multiple linear regression analysis.Results Patients who took suicide by pesticides incurred medical expenses of RMB 3081681.81,per capita cost(M)was RMB 17278.94,those who took suicide by drugs had a total medical cost of RMB 870745.15,and expenses per capita(M)were RMB 11457.17,and the patients who selected other types of poisoned suicides generated the cost of 133252.03 yuan,and the per capita cost(M)was 8221.83 yuan.Age,length of hospitalization and hemoperfusion were common factors that affect the medical costs of pesticides and drug self-poisoning patients.Ventilator-assisted ventilation was the specificity that affects the medical costs of pesticide self-poisoning.Conclusion Hospitals could control patients’expenses by implementing bi-directional referral and informed consent,standardizing the indications and quality management of hemoperfusion and ventilator-assisted respiration technologies,and improving the capacity of primary medical institutions.