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目的探讨临床路径管理下的菌阳肺结核患者的住院费用及其影响因素,为控制患者住院费用提供参考依据。方法收集天津市海河医院2014年1月1日至2016年12月31日临床路径管理下1 646例出院诊断为初治菌阳肺结核和复治菌阳肺结核患者的基本情况、住院天数、是否手术、疾病转归、医疗付费方式、住院次数、住院年份和住院费用等信息。采用SPSS 19.0软件进行多元线性逐步回归分析住院费用的影响因素。结果 1 646例患者中,男性1 263例(76.73%),女性383例(23.27%);初治菌阳肺结核患者1 295例(78.68%),复治菌阳肺结核患者351例(21.32%)。患者的住院天数中位数为13 d(P_(25)~P_(75):10~15 d),住院费用中位数为12 007.61元(P_(25)~P_(75):9 397.20~15 540.99元)。多元线性逐步回归分析结果显示,对住院费用影响程度由大到小排列依次为住院天数(β=0.692)、年龄(β=0.209)、手术与否(β=0.103)和疾病转归(β=0.098),均有统计学意义(P<0.01)。结论在医院管理层面开展临床路径,有利于降低医疗费用,提高患者满意度。住院时间越长、年龄越大、进行手术、疾病转归为死亡的菌阳肺结核患者住院费用高。
Objective To explore the hospitalization costs and influencing factors of patients with bacillary positive pulmonary tuberculosis under clinical path management and to provide reference for controlling the hospitalization costs of patients. Methods The data of 1 646 discharged patients diagnosed as untreated bacillary positive pulmonary tuberculosis and retreatment positive pulmonary tuberculosis under the clinical pathway management from January 1, 2014 to December 31, 2016 in Haihe Hospital of Tianjin were collected. The hospitalization days, , Disease outcome, medical payment, number of hospitalizations, length of hospitalization and hospitalization costs. SPSS 19.0 software was used to perform multiple linear stepwise regression analysis of hospitalization costs. Results Among 1 646 patients, 1 263 (76.73%) were male and 383 (23.27%) were female. There were 1 295 (78.68%) of the newly diagnosed bacillary positive pulmonary tuberculosis and 351 (21.32%) of the newly diagnosed bacillary positive pulmonary tuberculosis . The median length of hospital stay was 13 days (P 25-75): 10-15 days, and the median hospitalization expense was 12 007.61 yuan (P 25-75) 9 397.20 ~ 15 540.99). Multivariate linear stepwise regression analysis showed that the influence degree of hospitalization cost from hospital to hospital were as follows: length of hospital stay (β = 0.692), age (β = 0.209), operation or not (β = 0.103) 0.098), were statistically significant (P <0.01). Conclusions The clinical approach to hospital management is conducive to reducing medical costs and improving patient satisfaction. The longer the hospitalization, the older, the operation, and the disease goes to the death of bacteria positive pulmonary tuberculosis hospitalization costs are high.