基于病例组合制定甲状腺疾病患者住院费用标准的研究.pdfVIP

中国卫生事业管理 2015 年第9 期(总第327 期) 基于病例组合制定甲状腺疾病患者住院 费用标准的研究* 朱虹1 ，刘兰茹IA ，张小波2 ，刘鹏3 (1.哈尔滨医科大学人文社会科学学院，黑龙江哈尔滨 15仪削;2. 哈尔滨医科大学附属第四医院; 3. 哈尔滨医科大学地病中心) [摘要] 目的:研究甲状腺疾病患者住院费用及影响因素，进行病例组合分类，制定支付费用标准。方法:筛选哈尔 滨市某综合三甲医院2010 年 1 月 1 日 -2010 年 12 月 31 日期间住院治疗的甲状腺疾病患者，采用多元逐步回归对其住 院费用的主要影响因素进行研究，采用决策树中卡方自动互动检验法进行病例纽合分类，并计算标准费用。结果:有无其 他诊断、年扮、住院夭数、入院情况、是否手术是影响甲状腺疾病患者住院费用的主要因素，其中是否手术与住院天数作为 有效节点，将患者分为 4 类不同的病例组合。结论:制定更加合理的费用支付标准以及逐步建立疾病诊断相关分纽的结 算方式是控制医疗费用的重要途径。 [关键词] 甲状腺疾病;住院费用;影响因素;病例组合;支付标准 [中图分类号] R 195 [文献标i只码] A [文章编号] 1ω4-4663(2015)09 -663 -03 Stud抖og 00 tbe 剖andanl of hospitalizatioo e碍enses of inpatieots witb tbyroid dis四se based 00 case mix./Zhu Hoog ,et al. / /The Chinωe Health Service Managemeot. Abs衍act Objective To analyze the hospitalization expenses of inpatients with thyroid disease and ils inf1uencing factors ,and fonnulate the standard. Methods Inpatients 叨th thyroid disease hospitalized in a grade three and first-class hospital of Harbin from Janu缸Y to Decemher ,2010 were sampled and analyzed with multiple step切se regression method. The case mix w部 classified with Chi-squared Automatic InteractÍon Detector. And the standard expenses were calculated. Results ηle main factors to inf1uence 由e hospitalization expenses of inpatients wi出 thyroid disease were diagnosis ,age ,hospitalized duration ,admission condition and surger- y ,in which the factors of surgery and hospitalized duration we陀 the active factors to classify the inpatients into four different case- mixes. Conclusion It is suggested to develop more reasonable expense standard and gradually establish payment on diagnosis-related g