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【摘要】 目的 探讨以病例分型为基础的质量费用管理方式,用于分析同一病种不同病情的患者所花费的医疗费用和住院日之间的差别。方法 对呼吸内科751例和综合内科776例肺部感染患者进行病例分型,分别统计A、B、C、D型的医疗费用和住院日。结果 不同分型患者之间医疗费用和住院日都有显著性差异;呼吸内科A、C型医疗费用和C型住院日较综合内科少,差异有统计学意义;综合内科C型率较呼吸内科高,呼吸内科D型率较综合内科高,P<0.001。结论 应用病例分型有助于科学控制和合理评价患者医疗费用高低和住院日长短,也为真实反映不同医疗单位的诊疗质量和效率提供客观的依据。
【关键词】 肺部感染;病例分型;医疗费用;住院日
Application of disease-case classification in evaluation on medical cost and hospitalization date
WU Li-jun, YE Hui-qing, WENG Su-xia.Shantou central hospital, Shantou 515031,China
【Abstract】 Objective To discuss how to apply the quality cost management mode that is based on disease-case classification for analyzing the difference of medical cost and hospitalization date between patients who have the same disease but in different condition. Methods Divide patients with lung infection including 751 cases of respiratory department of medicine and 776 cases of integrated department of medicine into A, B, C and D categories;analyze the medical cost and hospital stay length using statistical methods. Results The
DOI:10.3760/cma.j.issn 1673-8799.2010.11.185
作者单位:515000广东省汕头市中心医院
medical cost and hospital stay length have significant difference between patients with different disease-case classification. The medical cost of respiratory department of medicine from categories A and C as well as the length of hospital stay of category C are less than the integrated department of medicine, which has showed the significant difference in statistics. The rate of the integrated department of medicine category C is higher than the respiratory department of medicine, the rate of the respiratory department of medicine category D is higher than the integrated department of medicine category, and P<0.001. Conclusion The application of disease-case classification will benefit to scientifically control and rationally evaluate the patients’ medical cost and hospital stay length. It will also provide objective evidence for truly reflecting the clinic quality and efficiency of different medical units.
【Key words】Lung Infection;Disease-case classification;Medical cost;Hospitalization date
病例的复杂性和病情严重度是影响医疗效果和卫生资源消耗的重要因素,同一个病种的病例,医疗质量、费用成本往往因病情不同而差距很大,故现行的单纯按病种划分的质量、费用管理方式存在缺乏可比性等缺陷。本文通过对肺部感染患者按病情进行病例分型,探讨科学的新的医疗质量费用管理方式的应用。
1 资料与方法
1.1 一般资料 根据ICD-10编码检索2008年我院主要诊断为肺部感染的住院患者,筛除无效住院日病例之后,呼吸内科751例,综合内科776例,住院费用经剔除与诊疗无直接关系的项目之后作为医疗费用来统计。
1.2 方法
1.2.1 病例分型 选取与病情密切相关的变量,如:入院时情况,有无并发症和合并症,入出院诊断符合情况,确诊日期,会诊情况,是否抢救,疗效,年龄,护理等级,有无输氧,有无特殊操作如支气管纤维镜检查、胸腔穿刺术、气管插管等,应用Visual foxpro软件计算机编程对病例判别分型,将所有病例分为四型:A型(单纯普通型)、B型(单纯急症型)、C型(复杂疑难型)、D型(复杂危重型)。
1.2.2 评价指标和统计方法 分别计算呼吸内科和综合内科各型肺部感染患者的平均住院日和平均日均医疗费用,用(x±s)表示,方差分析各型之间的差异,t检验科室之间的差异;计算两个科室的C型率、D型率, χ2检验其差异有无统计学意义。
2 结果
比较两个科室各型肺部感染患者的医疗费用和住院日(如下表1、表2),除B型病例因例数较少不做统计学对比之外,不同分型患者之间医疗费用和住院日都有显著性差异(P<0.001),D型医疗费用和住院日都最高,其次为C型,A型最低;呼吸内科A、C型医疗费用和C型住院日都较综合内科少,P<0.05或P<0.001, 其他差异无统计学意义。两个科室的病例类型构成有明显不同,综合内科C型率69.85%显著较呼吸内科C型率44.87%高;呼吸内科D型率39.28%较综合内科22.55%高,经χ?检验,P<0.001。
表1
呼吸内科和综合内科各型肺部感染患者的平均日均医疗费用 (x±s,元)
【关键词】 肺部感染;病例分型;医疗费用;住院日
Application of disease-case classification in evaluation on medical cost and hospitalization date
WU Li-jun, YE Hui-qing, WENG Su-xia.Shantou central hospital, Shantou 515031,China
【Abstract】 Objective To discuss how to apply the quality cost management mode that is based on disease-case classification for analyzing the difference of medical cost and hospitalization date between patients who have the same disease but in different condition. Methods Divide patients with lung infection including 751 cases of respiratory department of medicine and 776 cases of integrated department of medicine into A, B, C and D categories;analyze the medical cost and hospital stay length using statistical methods. Results The
DOI:10.3760/cma.j.issn 1673-8799.2010.11.185
作者单位:515000广东省汕头市中心医院
medical cost and hospital stay length have significant difference between patients with different disease-case classification. The medical cost of respiratory department of medicine from categories A and C as well as the length of hospital stay of category C are less than the integrated department of medicine, which has showed the significant difference in statistics. The rate of the integrated department of medicine category C is higher than the respiratory department of medicine, the rate of the respiratory department of medicine category D is higher than the integrated department of medicine category, and P<0.001. Conclusion The application of disease-case classification will benefit to scientifically control and rationally evaluate the patients’ medical cost and hospital stay length. It will also provide objective evidence for truly reflecting the clinic quality and efficiency of different medical units.
【Key words】Lung Infection;Disease-case classification;Medical cost;Hospitalization date
病例的复杂性和病情严重度是影响医疗效果和卫生资源消耗的重要因素,同一个病种的病例,医疗质量、费用成本往往因病情不同而差距很大,故现行的单纯按病种划分的质量、费用管理方式存在缺乏可比性等缺陷。本文通过对肺部感染患者按病情进行病例分型,探讨科学的新的医疗质量费用管理方式的应用。
1 资料与方法
1.1 一般资料 根据ICD-10编码检索2008年我院主要诊断为肺部感染的住院患者,筛除无效住院日病例之后,呼吸内科751例,综合内科776例,住院费用经剔除与诊疗无直接关系的项目之后作为医疗费用来统计。
1.2 方法
1.2.1 病例分型 选取与病情密切相关的变量,如:入院时情况,有无并发症和合并症,入出院诊断符合情况,确诊日期,会诊情况,是否抢救,疗效,年龄,护理等级,有无输氧,有无特殊操作如支气管纤维镜检查、胸腔穿刺术、气管插管等,应用Visual foxpro软件计算机编程对病例判别分型,将所有病例分为四型:A型(单纯普通型)、B型(单纯急症型)、C型(复杂疑难型)、D型(复杂危重型)。
1.2.2 评价指标和统计方法 分别计算呼吸内科和综合内科各型肺部感染患者的平均住院日和平均日均医疗费用,用(x±s)表示,方差分析各型之间的差异,t检验科室之间的差异;计算两个科室的C型率、D型率, χ2检验其差异有无统计学意义。
2 结果
比较两个科室各型肺部感染患者的医疗费用和住院日(如下表1、表2),除B型病例因例数较少不做统计学对比之外,不同分型患者之间医疗费用和住院日都有显著性差异(P<0.001),D型医疗费用和住院日都最高,其次为C型,A型最低;呼吸内科A、C型医疗费用和C型住院日都较综合内科少,P<0.05或P<0.001, 其他差异无统计学意义。两个科室的病例类型构成有明显不同,综合内科C型率69.85%显著较呼吸内科C型率44.87%高;呼吸内科D型率39.28%较综合内科22.55%高,经χ?检验,P<0.001。
表1
呼吸内科和综合内科各型肺部感染患者的平均日均医疗费用 (x±s,元)