文献类型：期刊文献

中文题名：基于分级诊疗政策下糖尿病患者住院费用影响因素通径分析

英文题名：Pathway Analysis of Factors Influencing Hospitalization Expenditure of Diabetic Patients based on the Grading Diagnosis and Treatment Policy

作者：杨敬宇[1];雷丹[2];刘旭栋[3];钱亚玲[2]

第一作者：杨敬宇

机构：[1]甘肃中医药大学经贸与管理学院,甘肃兰州730000;[2]兰州大学公共卫生学院,甘肃兰州730000;[3]甘肃省妇幼保健院,甘肃兰州730000

第一机构：甘肃中医药大学经贸与管理学院

年份：2020

卷号：37

期号：4

起止页码：426

中文期刊名：中国社会医学杂志

外文期刊名：Chinese Journal of Social Medicine

收录：CSTPCD

基金：国家社科基金项目(13XMZ031)。

语种：中文

中文关键词：分级诊疗;糖尿病;住院费用;通径分析

外文关键词：The grading diagnosis and treatment policy;Diabetes;Hospitalization expense;Pathway analysis

摘要：目的探讨分级诊疗政策下糖尿病患者住院费用的主要影响因素,为合理控制医疗费用增长,有效降低糖尿病患者疾病经济负担及推进慢性病分级诊疗提供参考依据。方法通过甘肃省新农合管理中心数据平台获取2015—2017年甘肃省(除兰州市、金昌市)糖尿病分级诊疗患者住院病历资料,包括患者基本情况、诊断信息、及住院费用信息,采用描述性统计和多元线性回归分析法并拟合通径模型,研究分级诊疗下糖尿病患者住院费用的影响因素。结果2017年分级诊疗糖尿病患者人均住院费用为2378.79元,较2015年降低315.46元;住院天数是直接影响糖尿病患者住院费用的首要因素,年龄通过住院天数间接影响住院费用,且与住院天数呈正相关;药占比、首诊医院级别、有无并发症和疾病类型与住院费用呈正相关,分级诊疗实施年度和转诊状态与住院费用呈负相关。结论住院天数是影响糖尿病患者住院费用的首要因素,而基层首诊、转诊制度及政策实施年度等分级诊疗政策因素也是控制慢病费的有效方式,应进一步落实糖尿病分级诊疗规范及临床路径,优化诊疗流程,完善双向转诊,来减轻患者和社会的经济负担。
Objective To analyze the major factors influencing hospitalization expenses of diabetes patients based on the Grading diagnosis and treatment policy,and provide a reference to adjust the current high medical expenses,reduce patients economic burden and promote the smooth implementation of grading diagnosis and treatment of chronic diseases.Methods Based on the data platform of Gansu New Rural Cooperative Medical Management Center,the data of diabetes patients'hospitalization records in Gansu province(except Lanzhou and Jinchang)from 2015 to 2017 were obtained,including patients'basic information,diagnosis information and hospitalization expenses.Descriptive statistics and multiple linear regression analysis were used to study the influencing factors of hospitalization expenses of diabetic patients under graded diagnosis and treatment.Results The average hospitalization expenses of diabetic patients in 2017 were 2378.79 yuan,which decreased of 315.46 yuan compared to 2015.Hospitalization days was the primary factor that directly affected hospitalization expenses of diabetic patients.Age indirectly affected hospitalization expenses through hospitalization days,and positively correlated with hospitalization days;Drug proportion,first-visit hospital level,complications,and disease types were positively correlated with hospitalization expenses,while the implementation year of graded diagnosis and treatment and referral status were negatively correlated.Conclusion Hospitalization days is the most important factor affecting hospitalization costs of diabetic patients.The policy factors of first consultation,referral system and policy implementation year are effective ways to control the costs.Therefore,it is an important content to further implement the criteria and clinical pathways of graded diagnosis and treatment of diabetes,optimize the process of diagnosis and treatment,and improve two-way referral to reduce the economic burden of patients and society.