江西省永新县芦溪乡卫生院2010年住院疾病与费用构成情况调查

目的调查2010年江西省永新县芦溪乡镇卫生院住院疾病构成及费用情况,了解当地疾病负担,为进一步研究提供基线数据。方法收集2010年该院住院病例资料,根据国际疾病分类编码(ICD-10)对出院记录的第一诊断进行疾病标化和系统归类,运用EXCEL 2003和SPSS 13.0等统计软件整理分析住院患者一般情况,出院诊断、医疗费用及使用基本药物情况等。结果①2010年芦溪乡院住院病例925人次,男女性别比为0.8;②住院系统疾病可分为17类,占ICD-10标准分类的81%;③前5类疾病依次为呼吸、消化、损伤中毒和外因、循环及泌尿生殖系统疾患,累计占82.27%;④前15位单病种依次为上呼吸道感染、骨折、慢性阻塞性肺病、慢性胃肠炎、脑血管病、泌尿系结石、类风湿性关节炎、椎间盘疾患、胆囊结石伴胆囊炎、心脏病、生殖器官疾病、损伤和中毒、肺炎、高血压及消化性溃疡;⑤上呼吸道感染和肺炎患者年龄均主要集中于≥65岁和<5岁;除了泌尿系结石和消化性溃疡外,其余8种慢性病患者的年龄均主要集中在≥65岁;⑥前15种单病种中,慢性病患者平均住院日及次均住院费用低于急性病(4.8天vs.11.6天;439.1元vs.666.9元);⑦芦溪乡镇卫生院住院费用虽逐年增加,但仍远低于全国乡院平均水平(542.3元vs.1 004.6元)。结论①2010年芦溪乡镇卫生院住院病例前3位系统疾病是呼吸、消化及损伤和中毒,其中前2种系统疾病均为女性多于男性;急性病多集中于感染和骨折。②前15位单病种中除类风湿性关节炎、胆囊结石伴胆囊炎、心脏病、生殖器官疾病和消化性溃疡外,其余10种单病种与四川永安乡院基本相同。③呼吸系统、损伤和中毒以急性病为主;消化、循环、泌尿生殖及肌肉骨骼和结缔组织系统以慢性病为主。④急慢性病在35岁以后年龄段患者呈显著增加趋势,且女性多于男性;≤15岁和≥35岁急性病患者的疾病负担均较重。⑤上呼吸道感染和肺炎患者均主要集中于老年人和儿童。⑥与甘肃新添乡院(基本型)相比,芦溪乡院骨折患者平均住院日长(43.7天vs.9天),次均住院费用高(1 948.0元vs.1 646.3元),疾病负担重(8.11%vs.4.85%)。⑦急性病患者平均住院日远高于四川永安(小康型)和甘肃新添(基本型)乡院(11.6天vs.3.7天、6.2天),但次均住院费用却远低于两院(666.9天vs.850.4元、906.85元)。

A Status Survey on Inpatient Diseases Constitution and Hospitalization Expenses in Luxi Township Health Center, Yongxin County of Jiangxi Province, in 2010

Objective To Investigate the disease constitution and hospitalization expense in Luxi township health center （LxC） in Yongxi county of Jiangxi Province in 2010, to make clear about the local burden of diseases and to provide the baseline data for further study. Methods The inpatient records of L×C in 2010 were collected. Based on the primary diagnosis on hospital discharge record, the diseases were standardized and classified according to the International Classification of Disease, 10th Edition （ICD-10）. Data including general information of the inpatients, discharge diagnosis, hospitalization expense and usage of essential medicine etc, were reorganized and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a） The total number of inpatients were 925 in 2010, with male/female ratio of 0.8; b） The disease spectrum included 17 categories, accounting for 81% of the ICD-10; c） The top 5 diseases were in respiratory, digestive, injury, poisoning ＆ external causes, circulatory and genitourinary system, totally accounting for 82.27%; d） The top 15 single diseases were upper respiratory infection, fracture, chronic obstructive lung disease （COPD）, chronic gastroenteritis, cerebrovascular disease （CVD）, calculi in urinary system, rheumatoid arthritis, intervertebral discs diseases, cholecyslithiasis accompanied with cholecystitis, cardiac disease, reproductive organ diseases, injury ＆ poisoning, pneumonia, hypertension and peptic ulcer; e） The patients with upper respiratory infection and pneumonia were mostly older than 65 or younger than 5 years old. With the exception of calculi in urinary system and peptic ulcer, all the other 8 chronic diseases were mainly seen in patients over 65 years old; f） Among the 15 single diseases as listed above, the chronic diseases were associated with shorter average hospital stay and low average expense compared with the acute diseases （4.8 d vs. 11.6 d; ￥439.1 vs. ￥666.9）; and g） The hospitalization expense of LxC, although increasing year by year, was still far below that of the national township health centers （￥542.3 vs. ￥1 004.6）. Conclusion a） The top 3 in inpatients systematic diseases of L×C are respiratory system, digestive system, and injury and poisoning; the former 2 diseases attack more often in females, and the acute diseases are mainly infection and fracture; b） Except for rheumatoid arthritis, chol-ecyslithiasis accompanied cholecystitis, cardiac diseases, reproductive organ diseases and peptic ulcer, all the other 10 of the top 15 single diseases are similar to Yong＇an township health center （YaC） in Sichuan Province in 2010; c） The acute diseases mainly focus on respiratory system, and injury and poisoning, and the chronic diseases mainly focus on digestive system, circulatory system, genitourinary system, the musculoskeletal system and connective tissue system; d） The number of patients who suffer from chronic diseases increases significantly when over of 35 years old, especially, often seen in fe- male rather than male. The acute burden diseases is serious in patients less than 15 or more than 45 years old; e） The upper respiratory infection and pneumonia mainly affect the old and children; f） Compared with Xintian township health center （XtC） in Gansu Province, the average hospital stay of fracture patients is longer （43.7 d vs. 9.0 d）, the hospitalization expense is higher （￥1 948.0 vs. ￥1 648.3）, and the diseases is burden heavier （8.1% vs. 4.9%）; and g） The average hospital stay of patients with acute diseases is longer than YaC and XtC （11.6 d vs. 3.7 d, 6.2 d）, but the hospitalization expense is lower than both of them （7666.9 vs. 7850.4, 7906.9）.