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.

Study on the factors affecting hospitalization expenses for PCI inpatients and criteria for expenses control

Objective To analyze inpatient expenses of percutaneous coronary intervention (PCI) and factors in the department of cardiology of a hospital, in order to provide references for setting the upper expenses limit and keeping expenses within a reasonable control Methods The hospitalization expenses data were collected from inpatients having intracoronary stenting operations in a class 3 grade A hospital in Shanghai from 2004-2006. The study made multi-factor analysis on factors possibly affecting the expenses, and built a model to predict the expense per disease, and estimated the upper limit for medical insurance expense control. These figures were used in an expense appraisal for inpatients from January to June in 2007. Results For the expenses of the 1296 PCI inpatients investigated, the largest share, 84.11%, comes from operation materials. Factors affecting the expenses, as listed by their influence, were in turn the number of stents used, length of stay, age, the status at admission, and rescues made. The study found that the average hospitalization expenses of inpatients from January to June in 2007 fell below the middle control line, and 85% of them lower than the upper control line. Conclusions To lower the medical expenses for the disease, hospitals need to take measures by using less stents, less days of stay, and less medication. Control lines specified per disease can help manage and control medical treatment quality.