發(fā)布時間：2018-04-26 05:07

  本文選題：囊型肝包蟲病 + 住院費用��； 參考：《石河子大學》2017年碩士論文

【摘要】：目的:通過對新疆地區(qū)9家經(jīng)規(guī)范化培訓的師、市級醫(yī)院2005-2013年收治的囊型肝包蟲病患者規(guī)范化治療前后住院費用及影響因素進行分析,了解肝包蟲病患者住院費用現(xiàn)況,探討其主要的影響因素;同時采用成本-效果評價方法對規(guī)范化治療前和規(guī)范化治療后肝包蟲病不同手術方式在不同時期、不同級別醫(yī)院的有效性和經(jīng)濟性進行綜合評價。方法:本研究采用回顧性調(diào)查方法選取2005-2013年新疆地區(qū)9家經(jīng)規(guī)范化培訓的醫(yī)院收治的囊型肝包蟲病手術住院患者為研究對象,以2010年為界,分為規(guī)范前和規(guī)范后,所有研究對象均至少隨訪2年,共收集有效病歷900例。通過現(xiàn)場調(diào)閱病案、術后B超或CT結果的方式收集問卷信息,包括患者一般情況、手術方式、醫(yī)院級別、術后是否膽漏、是否殘腔感染及費用明細等信息。應用SPSS 20.0軟件進行統(tǒng)計分析,計量資料采用均數(shù)、中位數(shù)及四分位數(shù)間距描述,兩組間比較采用t檢驗或非參秩和檢驗,多組間比較采用方差分析或非參秩和檢驗,計數(shù)資料采用χ2檢驗或Fisher精確概率法,多因素分析采用多元回歸分析,成本-效果分析采用成本-效果比、增量成本效果比和敏感度分析。結果:1.人均住院費用隨年份增長呈上升趨勢,由2005年10865.02元上升到2013年22260.77元,增長了1.05倍,差異均有統(tǒng)計學意義(P0.05);人均住院費用規(guī)范化治療前為13533.15元,規(guī)范化治療后為19680.02元;且規(guī)范化治療前后均以藥品費(38.36%、38.40%)和手術費為主(24.62%、18.99%)。2.規(guī)范化治療前人均住院費用的影響因素依次是醫(yī)院級別、住院天數(shù)、年齡和手術方式(P0.05);規(guī)范化治療后人均住院費用的影響因素依次是醫(yī)院級別、住院天數(shù)、年齡、年份和囊腫數(shù)目(P0.05)。3.二級醫(yī)院規(guī)范化治療前四種手術方式C/E依次為139.16、134.10、158.23、118.69;△C/△E依次為-321.94、245.70、48.99;敏感度分析結果與成本-效果分析結果一致;4.二級醫(yī)院規(guī)范化治療后四種手術方式C/E依次為209.40、182.56、176.10、158.42;△C/△E依次為31.84、91.20、14.21;敏感度分析結果與成本-效果分析結果一致。5.三級醫(yī)院規(guī)范化治療前四種手術方式C/E依次為371.86、253.44、254.12、218.86;△C/△E依次為-189.70、-187.53、2155.95;敏感度分析結果與成本-效果分析結果一致。6.三級醫(yī)院規(guī)范化治療后四種手術方式C/E依次為520.59、380.98、305.56、265.39;△C/△E依次為-315.71、-441.17、1257.26;敏感度分析結果與成本-效果分析結果一致。結論:新疆肝包蟲病患者規(guī)范化治療前后人均住院費用均隨年份的增長、住院天數(shù)的延長、年齡的增長呈逐年上升趨勢,且均以藥品費和手術費為主;規(guī)范化治療前人均住院費用的影響因素是醫(yī)院級別、住院天數(shù)、年齡和手術方式,規(guī)范化治療后人均住院費用的影響因素是醫(yī)院級別、住院天數(shù)、年齡、年份和囊腫數(shù)目;外膜內(nèi)外囊完整切除術是適宜不同級別醫(yī)院、不同階段的即有效又經(jīng)濟的最理想手術方式,值得實施推廣。
[Abstract]:Objective: to analyze the hospitalization expenses and influencing factors of 9 standardized trained teachers and municipal hospitals in Xinjiang region from 2005 to 2013 before and after standardized treatment for patients with hepatic hydatid disease, so as to understand the current situation of hospitalization expenses of patients with hepatic hydatid disease. At the same time, the cost-effect evaluation method was used to evaluate the effectiveness and economy of different surgical methods of liver hydatid disease in different stages and different stages. Methods: a retrospective study was conducted in 9 hospitals in Xinjiang from 2005 to 2013. The patients with cystic liver hydatid disease were selected as the study subjects. The patients were divided into two groups: before and after the standardization. All subjects were followed up for at least 2 years and 900 effective medical records were collected. The information of questionnaire was collected by reading the medical records on the spot, the results of B ultrasound or CT after operation, including the general condition of the patients, the operation method, the hospital grade, the bile leakage after operation, the infection of residual cavity and the details of the expenses and so on. The statistical analysis was carried out by SPSS 20.0 software. The mean, median and quartile spacing were used to describe the measurement data. T test or non-parametric rank sum test were used for the comparison between the two groups, and the variance analysis or non-parametric rank sum test were used for the multigroup comparison. The counting data were analyzed by 蠂 ~ 2 test or Fisher accurate probability method, multivariate regression analysis, cost-effect ratio, incremental cost-effect ratio and sensitivity analysis. The result is 1: 1. The per capita hospitalization cost increased from 10865.02 yuan in 2005 to 22260.77 yuan in 2013, the difference was significant (P 0.05), the average hospitalization cost per capita was 13533.15 yuan before standardized treatment, 19680.02 yuan after standardized treatment, and the average per capita hospitalization cost increased from 10865.02 yuan in 2005 to 22260.77 yuan in 2013, the difference was statistically significant (P 0.05). And before and after the standardized treatment, 38.36 (38.40) and 24.622 (18.99) and operating expenses were mainly used. The influencing factors of per capita hospitalization cost before standardized treatment were hospital grade, hospitalization days, age and operation mode (P0.05N), and the influencing factors of per capita hospitalization cost after standardized treatment were hospital grade, hospitalization days, age, etc. Year and number of cysts P0.05. 3. The results of sensitivity analysis and cost effect analysis were consistent with the results of sensitivity analysis and cost-effect analysis. The C- / E was 139.16134.10U 158.23118.69 and C / E was -321.945.705.700.The results of sensitivity analysis were consistent with those of cost-effect analysis. The results of sensitivity analysis were consistent with that of cost-effect analysis. The C- / E of the four kinds of operation methods were 209.40182.56 / 176.10158.42 and 31.84 / 91.201.2014.21 respectively. The results of sensitivity analysis were consistent with those of cost-effect analysis. C / E of the first four modes of standardized treatment in tertiary hospitals was 371.86253.44 / 254.12218.86, and C / E was -189.70 / -187.53n 2155.95.The sensitivity analysis result was consistent with the cost-effect analysis result .6. After standardized treatment in tertiary hospitals, C / E was 520.59380.98 / 305.56265.39, and C / E was -315.71 / -441.17 / 1257.26.The results of sensitivity analysis were consistent with those of cost-effect analysis. Conclusion: before and after standardized treatment of liver hydatid disease patients in Xinjiang, the per capita hospitalization cost increased with the increase of years, the length of hospitalization days and the increase of age showed an increasing trend year by year. The influencing factors of per capita hospitalization cost before standardized treatment were hospital grade, hospitalization days, age and operation mode. After standardized treatment, the influencing factors of per capita hospital expenses were hospital grade, hospitalization days, age, year and number of cysts. The complete excision of internal and external capsule is the most effective and economical operation method in different level hospitals, and it is worth popularizing.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.3;R197.3

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