【摘要】：目的:調(diào)查2012-2016年青海省人民醫(yī)院包蟲病住院患者的病歷資料與住院費用,分析青海省人民醫(yī)院包蟲病患者住院費用總體狀況,明確影響住院費用的主要因素,為我省包蟲病醫(yī)療防治策略的制定和完善提供理論依據(jù)。方法:收集青海省人民醫(yī)院2012年1月至2016年12月的所有包蟲病住院患者病歷資料,包括一般信息、臨床資料信息及住院費用等信息,填寫自行編制的青海省包蟲病住院病例回顧性調(diào)查表,采用Epidata3.0建立青海省包蟲病住院患者信息數(shù)據(jù)庫,對所有調(diào)查表進行雙錄入并做一致性檢驗,所有合格調(diào)查表最終導入SPSS17.0軟件進行分析。應用非參數(shù)秩和檢驗對各影響因素(如病灶大小、是否手術等)進行單因素分析,應用多元線性回歸進行多因素分析,明確包蟲病患者住院費用的主要影響因素。結果:1.基本情況青海省人民醫(yī)院2012-2016年共收治包蟲病患者1,096例,年均住院病例數(shù)為219例/年,符合本研究要求的有952例,其中囊型和泡型包蟲病患者分別占79.41%(756例)、20.59%(196例);患者居住地以玉樹州、果洛州為主,分別占23.21%(221例)、19.43%(185例),再次為西寧市,占14.08%(134例);患者最小為7歲,最大為90歲,以31—45歲年齡段居多;患者以藏族居多,占70.20%(668例);職業(yè)分布可見,以農(nóng)牧民最多,占80.25%(764例);文化程度上以文盲為主,占60.08%(572例);醫(yī)保患者比例較高,占83.40%(794例);大多數(shù)患者住院天數(shù)為10—19天;手術患者占51.79%(493例),治愈與好轉(zhuǎn)率為95.94%(473例)。2.住院費用單因素分析調(diào)查顯示,住院費用中位數(shù)2012年為16,370.60元,2016年為21,524.40元,各年度間住院費用無顯著性差異(P0.05);分析表明,住院費用中位數(shù)中蒙古族為23,035.75元,藏族為17,779.25元,撒拉族僅為9,907.25元,民族間住院費用無顯著差異(P0.05);學生和牧民住院費用中位數(shù)分別為20,359.10元、19,202.75元,職業(yè)間住院費有顯著差異(χ2=17.230,P=0.0160.05);病灶大小以10cm住院費用中位數(shù)最高,為19,708.60元,其次為5—10cm 17,547.20元,不同病灶大小住院費用有顯著性差異(χ2=14.556,P=0.0010.05);肝功能分級以Child B級住院費用中位數(shù)最高為19,317.20元,不同肝功能分級住院費用有顯著性差異(χ2=8.694,P=0.0130.05);有并發(fā)癥患者的住院費用中位數(shù)高于無并發(fā)癥患者分別為26,438.40元和16,013.30元,二者住院費用有顯著性差異(Z=-7.958,P=0.0000.05);手術患者和非手術患者住院費用分別為24,681.30元、9,556.85元,二者間有顯著性差異(Z=-18.533,P=0.0000.05);疾病轉(zhuǎn)歸中,治愈患者住院費用最高,為24,771.55元,不同疾病轉(zhuǎn)歸住院費用有顯著性差異(χ2=291.890,P=0.0000.05);手術患者中,泡型包蟲病患者和囊型包蟲病住院費用分別為35,659.40元和23,389.80元,二者間有顯著差異(Z=-5.960,P=0.0000.05);住院費用中位數(shù)醫(yī)保患者高于自費患者,依次為18,219.50元、15,112.25元,醫(yī)保與自費包蟲病患者住院費用差別有統(tǒng)計學意義(Z=-2.139,P=0.0320.05)。囊型和泡型包蟲病患者不同影像分型住院費用差異不大(P0.05)。3.住院費用構成情況本研究中住院費用分析指標包括藥物費用(西藥、中藥以及草藥等)、檢查費用、耗材費用、手術費用以及其它費用,2012-2016年住院費用構成中藥品費、檢查費和耗材費分別為39.60%、28.84%、15.05%。4.影響因素包蟲病患者住院費用的影響因素是多方面的,分析結果顯示,入院年份(X7)、住院天數(shù)(X2)、是否手術(X8)、疾病轉(zhuǎn)歸(X13)、年齡(X1)、有無并發(fā)癥(X6)、入院時肝功能Child-Pugh分級(X12)、職業(yè)(X10)是主要影響因素。包蟲病住院費用影響因素回歸方程為:Y=-6,438,918.766+81.097X1+1,195.768X2-4,004.19X6+3,198.722X7-4,995.644X8-7,423.869X10+2,999.192X12+1,435.965X13(R2=0.52,F=35.35,P=0.0000.05)。結論:1.明確了青海省包蟲病住院患者的人群和地區(qū)分布特征,包蟲病患者的構成在民族、職業(yè)、文化程度、年齡、區(qū)域上都存在明顯差異,民族以藏族最多,職業(yè)以農(nóng)牧民最多,文化程度以文盲最多,年齡以青中年最多,區(qū)域以玉樹州、果洛州最多。2.明確了青海省包蟲病住院患者未愈率偏高的原因,因為就診時多數(shù)患者已處于病程中晚期,致使住院患者手術率低,未愈率高,患者預后欠佳。3.明確了青海省包蟲病患者的住院費用構成基本情況,以藥品費、檢查費、耗材費為主。4.明確了包蟲病患者住院費用主要影響因素,依次為住院天數(shù)、入院年份、是否手術、疾病轉(zhuǎn)歸、是否并發(fā)癥、年齡、入院時肝功能Child-Pugh分級、職業(yè)。
[Abstract]:Objective: To investigate the medical records and hospitalization expenses of the hospitalized patients with echinococcosis in Qinghai People's Hospital for 2012-2016 years, analyze the overall status of the hospitalization expenses of the patients with echinococcosis in the hospital and clarify the main factors that affect the hospitalization expenses, and provide the theoretical basis for the establishment and improvement of the medical treatment strategy of echinococcosis in our province. Method: collecting Qinghai All the medical records of all echinococcosis patients in the provincial people's Hospital from January 2012 to December 2016, including general information, clinical information and hospitalization expenses, filled in a retrospective questionnaire of the hospitalized cases of echinococcosis in Qinghai Province, and established the information database of inpatient in Qinghai province by Epidata3.0. Double entry and consistency test were carried out. All qualified questionnaires were finally introduced into SPSS17.0 software. Single factor analysis was carried out with non parametric rank sum test on the influence factors such as the size of the lesion, or not surgery, and multiple linear regression was used to analyze the main factors affecting the hospitalization expenses of hydatidosis patients. Results: 1. in Qinghai People's Hospital, there were 1096 cases of echinococcosis in Qinghai People's Hospital in 2012-2016 years. The average annual number of hospitalized cases was 219 / year, and 952 cases met the requirements of this study. 79.41% (756 cases) and 20.59% (196 cases) were cystic and alveolar echinococcosis, and the place of residence was mainly in Yushu and fruit, and 23.21% (221. 19.43% (185 cases), again in Xining, 14.08% (134 cases); the minimum of the patients was 7, the largest was 90 years old, with the majority of the age 31 to 45 years, the majority of the Tibetans, and 70.20% (668 cases); the occupational distribution was visible, the majority of the farmers and herdsmen, accounting for 80.25% (764 cases); the cultural degree was mainly illiterate, accounting for 60.08% (572 cases); the proportion of medical insurance patients was high. % (794 cases); most patients were hospitalized for 10 to 19 days; 51.79% (493 cases) were operated by patients (493 cases), and the cure and improvement rate of 95.94% (473 Cases) hospitalization cost single factor analysis showed that the median of hospitalization costs was 16370.60 yuan in 2012 and 21524.40 in 2016, and there was no significant difference in hospitalization expenses between each year (P0.05), and the analysis showed hospitalization fee. The median Mongolian nationality was 23035.75 yuan, the Tibetan was 17779.25 yuan, the Sarah nationality was only 9907.25 yuan, and the hospitalization expenses of the students and the herdsmen were 20359.10 yuan and 19202.75 yuan, respectively (P0.05), and the hospitalization fees of students and herdsmen were significantly different (x 2= 17.230, P=0.0160.05), and the size of the lesion was in the middle of the hospitalization expense of 10cm. The highest number was 19708.60 yuan, followed by 5 - 10cm 17547.20 yuan. The cost of hospitalization for different lesion sizes was significantly different (x 2=14.556, P=0.0010.05); the median of liver function classification at the median of Child B hospitalization costs was 19317.20 yuan, and the hospitalization expenses of different liver function grades were significantly different (x 2=8.694, P=0.0130.05); patients with complications had complications. The median of hospitalization costs was 26438.40 yuan and 16013.30 yuan higher than those without complications. The hospitalization expenses of the two patients were significantly different (Z=-7.958, P=0.0000.05); the hospitalization expenses of the patients and the non operative patients were 24681.30 yuan, 9556.85 yuan, respectively (Z=-18.533, P=0.0000.05). The cost of hospital was 24771.55 yuan, and the hospitalization expenses of different diseases were significantly different (x 2=291.890, P=0.0000.05). The hospitalization expenses of the patients with echinococcosis and cystic echinococcosis were 35659.40 yuan and 23389.80 yuan respectively, and there were significant differences between the two patients (Z= -5.960, P=0.0000.05); the median of hospitalization expenses was higher than that of the patients. 18219.50 yuan, 15112.25 yuan, medical insurance and self funded echinococcosis patients were in a significant difference (Z=-2.139, P=0.0320.05). The difference of hospitalization expenses of different imaging types of cystic and alveolar echinococcosis patients was not significant (P0.05).3. hospitalization expenses Medicine, traditional Chinese medicine and herbal medicine etc.), inspection expenses, cost of consumables, operation cost and other expenses, 2012-2016 years of hospitalization expenses constitute the cost of Chinese medicine, the cost of inspection and consumables are 39.60%, 28.84%, the influencing factors of the hospitalization expenses of the patients with echinococcosis by 15.05%.4. are many aspects, the results of analysis show that the admission year (X7), the days of hospitalization ( X2), whether surgery (X8), disease transfer (X13), age (X1), complication (X6), liver function Child-Pugh classification (X12) at admission and occupation (X10) are the main factors. The regression equation of the influencing factors of the hospitalization expenses of hydatidosis is: Y=-6438918.766+81.097X1 +1195.768X2-4004.19X6+3198.722X7-4995.644X8-7423.869X10+2999.192X12+1435.96 5X13 (R2=0.52, F=35.35, P=0.0000.05). Conclusion: 1. the population and regional distribution characteristics of echinococcosis in Qinghai province were clearly defined. The constitution of echinococcosis had obvious differences in ethnic, professional, cultural, age, and area. The ethnic group was the most Tibetan, the vocational and pastoral people were the most, the cultural degree was the most illiterate, the age was green and middle age. Most, in the region of Yushu and the largest.2. in the state of fruit in the state of Qinghai, it is clear that the unhealed rate of echinococcosis in Qinghai is high, because the majority of the patients are in the middle and late period of the disease, resulting in low rate of operation, high unhealing rate and poor prognosis of the patients, and the basic condition of the hospitalization expenses of the patients with echinococcosis in Qinghai province is made clear. The main factors affecting the hospitalization cost of echinococcosis patients were.4., inspection fee and cost of consumables, which were hospitalization days, hospitalization years, surgery, disease outcome, complications, age, Child-Pugh classification of liver function and occupation at admission.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.323;R532.32

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