發(fā)布時(shí)間：2018-03-18 04:36

  本文選題：醫(yī)院感染　切入點(diǎn)：直接經(jīng)濟(jì)負(fù)擔(dān)　出處：《河北大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：【研究目的】以保定市某綜合醫(yī)院為例,研究河北省中等城市2011-2015年醫(yī)院感染經(jīng)濟(jì)負(fù)擔(dān)動(dòng)態(tài)變化特征,探尋其發(fā)展變化規(guī)律,以期為因地制宜地制定河北省中等城市醫(yī)院感染經(jīng)濟(jì)負(fù)擔(dān)控制措施提供依據(jù)�！狙芯糠椒ā坎捎�1:1配比病例對(duì)照研究方法,以保定市某綜合醫(yī)院2011年1月~2015年12月間入院并發(fā)生醫(yī)院感染的病例作為病例組;按入院時(shí)間相近、住院科室和首要診斷相同等條件將未發(fā)生醫(yī)院感染的、同時(shí)期入院患者進(jìn)行1:1匹配作為對(duì)照組進(jìn)行研究。通過從該綜合醫(yī)院的醫(yī)院感染實(shí)時(shí)監(jiān)控系統(tǒng)、病案室及計(jì)算機(jī)中心,回顧性收集病例組和對(duì)照組的一般資料與各種醫(yī)療費(fèi)用,計(jì)算醫(yī)院感染的直接經(jīng)濟(jì)負(fù)擔(dān);依據(jù)住院天數(shù)分析醫(yī)院感染導(dǎo)致的患者本人及陪護(hù)家屬因誤工造成的經(jīng)濟(jì)損失來(lái)計(jì)算間接經(jīng)濟(jì)負(fù)擔(dān)。利用絕對(duì)增長(zhǎng)量、發(fā)展速度、增長(zhǎng)速度等指標(biāo)對(duì)5年內(nèi)經(jīng)濟(jì)負(fù)擔(dān)(直接與間接經(jīng)濟(jì)負(fù)擔(dān))動(dòng)態(tài)變化特征進(jìn)行分析�！狙芯拷Y(jié)果】1、醫(yī)院感染的現(xiàn)患率:2011年1月~2015年12月間,該綜合醫(yī)院共收治住院病例257369人,其中3745人發(fā)生醫(yī)院感染,平均現(xiàn)患率為1.46%。5年醫(yī)院感染現(xiàn)患率分別為1.57%、1.56%、2.21%、1.27%和0.84%。2、總體和平均直接經(jīng)濟(jì)負(fù)擔(dān)分析:按照1:1匹配條件,2993例匹配成功而進(jìn)入統(tǒng)計(jì)分析,其中男性1683例占56.23%,女性1310例43.77%。2011-2015年5年間2993例醫(yī)院感染病例總住院花費(fèi)為142,019,333.82元,其中因醫(yī)院感染而造成的直接經(jīng)濟(jì)負(fù)擔(dān)為69,101,048.86元,占總住院花費(fèi)的48.66%。2011-2015年5年的年度醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)分別為12,067,846.95元、13,029,734.64元、21,264,377.68元、16,480,574.02元和6,258,875.57元;人均直接經(jīng)濟(jì)負(fù)擔(dān)分別為14887.92元、18511.76元、16230.29元、15382.33元和8370.40元。5年平均發(fā)展速度為86.59%,平均增長(zhǎng)速度為-13.41%。5年間人均直接經(jīng)濟(jì)負(fù)擔(dān)總體下降6517.52元,下降了43.77%。3、不同費(fèi)用項(xiàng)目直接經(jīng)濟(jì)負(fù)擔(dān)分析:2011-2015年醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)為69,101,048.86元,其中西藥費(fèi)31,136,522.49元占45.06%,診療費(fèi)18,148,143.79元占26.26%,護(hù)理費(fèi)4,666,220占6.75%,化驗(yàn)費(fèi)4,467,061占6.46%�？梢娢魉幹С鏊黾拥慕�(jīng)濟(jì)負(fù)擔(dān)最多、其次為診療、化驗(yàn)和護(hù)理支出。從2011-2015年動(dòng)態(tài)分析結(jié)果來(lái)看,西藥費(fèi)2013年開始有明顯下降,與2011年比下降4101.35元,下降了32.49%;而診療、化驗(yàn)和護(hù)理支出在2013年均出現(xiàn)上升現(xiàn)象,2015年方開始下降。4、不同科室直接經(jīng)濟(jì)負(fù)擔(dān)分析:2011-2015年醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)為69,101,048.86元,其中神經(jīng)外科17,743,529.89元占25.68%,神經(jīng)內(nèi)科11,436,217.90元占16.55%,重癥醫(yī)學(xué)科5,264,595.00元占7.62%,血液內(nèi)科3,383,121.21元占5.55%,中西醫(yī)結(jié)合科2,626,754.04元占3.80%,骨科1,867,581.60元占2.70%。從5年人均直接經(jīng)濟(jì)負(fù)擔(dān)來(lái)看,神經(jīng)外科、神經(jīng)內(nèi)科、重癥醫(yī)學(xué)科、血液內(nèi)科等為歷年負(fù)擔(dān)較重科室,因此控制醫(yī)院感染經(jīng)濟(jì)負(fù)擔(dān)應(yīng)將上述科室列為重點(diǎn)科室。5、醫(yī)院感染間接經(jīng)濟(jì)負(fù)擔(dān)分析:2011-2015年因延長(zhǎng)人均住院天數(shù)分別為10天、9天、8天、8天和4天,按照當(dāng)年人均工資水平計(jì)算的間接經(jīng)濟(jì)負(fù)擔(dān)(患者本人和1名陪護(hù)家屬誤工費(fèi)用)分別為1684.40元、1677.96元、1675.98元、1829.44元和1006.44元。動(dòng)態(tài)分析表明,2014年有小幅上升,2015年很快回落,5年間共下降680.24元,下降了40.34%�！狙芯拷Y(jié)論】1、近5年該綜合醫(yī)院醫(yī)院感染平均現(xiàn)患率為1.46%,低于全國(guó)一般水平,但醫(yī)院感染的管理與控制仍任重而道遠(yuǎn)。2、2011-2015年間醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)占總住院費(fèi)用的48.66%。醫(yī)院感染大幅增加醫(yī)療費(fèi)用,給患者帶來(lái)沉重經(jīng)濟(jì)負(fù)擔(dān),浪費(fèi)衛(wèi)生資源。利用醫(yī)院感染實(shí)時(shí)監(jiān)控系統(tǒng)及時(shí)預(yù)警疑似病例,是控制醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)的重要方法。3、從費(fèi)用項(xiàng)目上分析,西藥費(fèi)、診療費(fèi)、化驗(yàn)費(fèi)和護(hù)理費(fèi)是醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)的重要構(gòu)成部分,是控制的重點(diǎn)費(fèi)用項(xiàng)目。4、從科室部門來(lái)看,神經(jīng)外科、神經(jīng)內(nèi)科、重癥醫(yī)學(xué)科、血液內(nèi)科等科室長(zhǎng)期居于前列,是控制和減少醫(yī)院感染直接經(jīng)濟(jì)負(fù)擔(dān)的重點(diǎn)科室部門。5、對(duì)醫(yī)院感染疑似病例及時(shí)預(yù)警,并根據(jù)藥敏試驗(yàn)結(jié)果規(guī)范使用抗生素等治療措施,是縮短住院天數(shù),降低間接經(jīng)濟(jì)負(fù)擔(dān)的重要途徑。
[Abstract]:[Objective] to a general hospital in Baoding city as an example, the dynamic characteristics of the economic burden of infection in Hebei province secondary city 2011-2015 years of hospital, to explore the law of development, in order to provide the basis for control measures according to local conditions to develop the economic burden of hospital infection in medium-sized city in Hebei province. [Methods] using 1:1 matched case-control study was conducted in Baoding City, a comprehensive hospital in January 2011 ~2015 December admitted to hospital and hospital infection cases as the case group; according to the admission time is similar to that of hospital and primary diagnosis of the same condition without nosocomial infection during the same period, patients were matched 1:1 as control group were studied. The infection from the comprehensive real-time monitoring system hospital, medical and computer center, were retrospectively collected from the patients and the control group of general information and medical expenses, calculation The direct economic burden of hospital infection; on the basis of analysis to calculate the indirect economic burden of hospital infection caused the patients themselves and their family members due to loss of economic losses caused by the number of days of hospitalization. The absolute increase in the amount, the speed of development, the growth rate as index of 5 years economic burden (direct and indirect economic burden) dynamic characteristics were analyzed. [results] 1, the prevalence rate of nosocomial infection: January 2011 ~2015 year in December, the hospital general hospital were treated in 257369 cases, of which 3745 people hospital infection, the average prevalence rate of prevalence rate of nosocomial infection was 1.57%, 1.46%.5 1.56%, 2.21%, 1.27% and 0.84%.2, and the average overall analysis the direct economic burden of 1:1: according to the matching condition, 2993 cases, and successfully entered into statistical analysis, including 1683 male cases accounted for 56.23%, 1310 women with 43.77%.2011-2015 and 5 years in 2993 cases of nosocomial infection cases in total Hospital cost is 142019333.82 yuan, the direct economic burden due to hospital infection caused by 69101048.86 yuan, accounting for the total hospitalization expenses of 48.66%.2011-2015 over the past 5 years the annual direct economic burden of hospital infection were 12067846.95 yuan, 13029734.64 yuan, 21264377.68 yuan, 16480574.02 yuan and 6258875.57 yuan per capita; the direct economic burden was 14887.92 yuan, 18511.76 yuan 16230.29 yuan, 15382.33 yuan and 8370.40 yuan, the speed of.5 average annual growth of 86.59%, the average growth rate for -13.41%.5 years, the direct economic burden per capita decreased 6517.52 yuan, down 43.77%.3, analysis of the direct economic burden of different project cost: 2011-2015 years of hospital infection direct economic burden of 69101048.86 yuan, of which 31136522.49 Yuan medicine costs accounted for 45.06%. Fee 18148143.79 yuan accounted for 26.26%, 4666220 nursing fees accounted for 6.75%, accounting for 4467061 of the 6.46%. visible test fees Increase the economic burden of most western medicine expenditure, followed by treatment, testing and nursing expenses. 2011-2015 years from the dynamic analysis results, the cost of Western medicine began in 2013 has decreased significantly, compared with 2011 down 4101.35 yuan, down 32.49%; while the treatment, testing and nursing expenses in the 2013 annual rise, 2015 began to decrease.4 analysis, the direct economic burden of different departments: 2011-2015 years of hospital infection direct economic burden of 69101048.86 yuan, of which 17743529.89 yuan accounted for 25.68% of the Department of Neurosurgery, Department of Neurology, 11436217.90 yuan accounted for 16.55%, severe medicine 5264595 yuan accounted for 7.62%, blood medicine 3383121.21 yuan accounted for 5.55%, 2626754.04 yuan accounted for 3.80%, combining Chinese and Western medicine, Department of orthopedics 1867581.60 yuan accounted for 2.70%. from 5 the annual per capita direct economic burden, Department of Neurosurgery, Department of Neurology, ICU, hematology, etc. in recent years due to the heavy burden of departments. This should be the Department as a key department.5 economic burden of hospital infection, hospital infection: analysis of indirect economic burden due to the extension of 2011-2015 years per capita hospitalization days were 10 days, 9 days, 8 days, 8 days and 4 days, indirect economic burden calculation according to the average wage level (I patients and 1 caregivers the family lost fees) were 1684.40 yuan, 1677.96 yuan, 1675.98 yuan, 1829.44 yuan and 1006.44 yuan. The dynamic analysis showed that there was a small rise in 2014, 2015 fall soon, a total of 5 years fell 680.24 yuan, down 40.34%. [conclusions] 1, nearly 5 years the average hospital general hospital infection prevalence rate 1.46%, lower than the national average level, but the management and control of hospital infection still go15 hospital infection during.22011-2015 the direct economic burden of the total hospitalization expenses of 48.66%. hospital infection greatly increased medical costs, patients brought by heavy Economic burden, waste of health resources. The hospital infection monitoring system timely warning of suspected cases, is an important method of controlling hospital infection in the direct economic burden of.3, analysis, medicine charge, fee from fees, testing fees and nursing is an important part of the direct economic burden of hospital infection, is the focus of project cost control.4, from the Department of department, Department of Neurosurgery, Department of Neurology, ICU, hematology department is in the forefront of long-term, hospital infection control and reduce the direct economic burden of key departments Department of.5, hospital infection of suspected cases timely warning, and according to the results of drug sensitive test to regulate the use of antibiotics and other treatment measures is to shorten the hospitalization number of days, an important way to reduce the indirect economic burden.

【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.32

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