上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（公共卫生） • 上一篇    下一篇

单病种质量管理实施前后急性心肌梗死的住院费用评价

刘雯薇1，杨静2，袁素维3，危凤卿3，马进3   

  1. 上海交通大学 1.安泰经济与管理学院， 上海 200052； 2.医学院附属瑞金医院医务处， 上海 200025； 3.公共卫生学院， 上海 200025
  • 出版日期:2015-06-28 发布日期:2015-07-30
  • 通讯作者: 马进, 电子信箱: majin@shsmu.edu.cn。
  • 作者简介:刘雯薇（1986—）， 女， 博士生; 电子信箱: sarabilau2@sjtu.edu.cn。
  • 基金资助:

    国家自然科学基金（71273175）；上海市卫生和计划生育委员会/上海创新医学基金项目（SJYF2014XD003B）；国家卫生和计划生育委员会项目（2013HFPC01）；上海市教委基金(13YS022)

Evaluation of hospitalization expense of patients with acute myocardial infarction before and after implementation of single disease quality control

LIU Wen-wei1, YANG Jing2, YUAN Su-wei3, WEI Feng-qing3,  MA Jin3   

  1. 1.Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai 200052, China; 2.Department of Medical Administration, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 3.School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
  • Online:2015-06-28 Published:2015-07-30
  • Supported by:

    National Natural Science Foundation of China, 71273175; Shanghai Municipal Commission of Health and Family Planning/Shanghai Medical Innovation Funding Project, SJYF2014XD003B; National Health and Family Planning Commission Project, 2013HFPC01; Shanghai Education Commission Foundation, 13YS022

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摘要：

目的 对上海市某三级甲等医院单病种质量管理实施前后急性心肌梗死患者的住院费用进行分析评价并提出建议。方法 回顾性分析该院2007—2013年主要诊断为急性心肌梗死的出院患者的病历资料，摘录病历首页的人口社会信息、疾病诊疗信息和费用信息。分析各项费用在单病种质量控制管理实施前后的情况，对住院总费用的影响因素进行逐步回归分析。结果 单病种质量控制管理实施后（2010年起），住院总费用、药费和手术费降低，而检查费和治疗费有所增加；对住院总费用变异影响显著的变量主要有住院日、是否手术、是否输血、性别、是否在质量管理实施后入院以及是否转科。结论 实施单病种质量管理后，急性心肌梗死住院患者的总费用有所下降，结构趋于合理化；住院总费用的变异主要受住院日以及病情的影响；从长期来看，减少急性心肌梗死患者的住院总费用应从进一步减少住院日以及提高医疗服务质量着手。

关键词: 单病种质量管理, 急性心肌梗死, 住院费用

Abstract:

Objective To analyze and evaluate the hospitalization expense of patients with acute myocardial infarction before and after the implementation of single disease quality control in a tertiary grade A hospital in Shanghai and propose suggestions. Methods Medical records of discharged patients who had diagnosed with acute myocardial infarction between 2007 and 2013 were retrospectively analyzed. The socio-economic characteristics, disease diagnosis and treatment, and expense information on the first page of medical records were collected. Expenses before and after the implementation of single disease quality control were analyzed. The stepwise regression analysis was adopted to analyze the influencing factors of total hospitalization expense. Results After the implementation of single disease quality control (since 2010), the total hospitalization expense, medicine expenses, and surgery expenses decreased, while the examination and treatment expenses increased. The hospitalization time, operation, blood transfusion, gender, admitted after the implementation of single disease quality control, and transfer were major factors that significantly influenced the total hospitalization expense. Conclusion After the implementation of single disease quality control, the total expense of inpatient with acute myocardial infarction decreases and the structure of expenses tend to be rationalized. The hospitalization time and illness are major factors that significantly influence the total hospitalization expense. In the long run, we should further reduce the hospitalization time and improve the quality of medical services in order to decrease the total hospitalization expense of patients with acute myocardial infarction.

Key words: single disease quality management, acute myocardial infarction disease, inpatient expenses