本文關鍵詞： 居民 職工 2型糖尿病 住院費用 并發(fā)癥 多元線性回歸 結(jié)構方程模型　出處：《天津醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:整理天津市2010-2014年醫(yī)療保險數(shù)據(jù)庫中2型糖尿病患者住院資料,認識糖尿病患者的基本信息和住院情況,分析患者并發(fā)癥的數(shù)目和類型,住院費用的組成,進而研究費用的變化走向,以及影響因素,為降低糖尿病患者的住院費用和醫(yī)療保險政策的制定提供理論支持,進而為我國今后糖尿病患者的管理工作提供依據(jù)。方法:數(shù)據(jù)取自天津市醫(yī)保數(shù)據(jù)庫,隨機抽取50%,選擇2型糖尿病患者的出院病例749741例,對患者的基本情況和住院費用進行分析。首先對職工和居民糖尿病患者的住院費用及其構成的變化趨勢進行描述,再結(jié)合不同患者的并發(fā)癥數(shù)量和類型,采用秩和檢驗分析住院費用的影響因素,根據(jù)結(jié)果運用多元線性回歸和結(jié)構方程模型探討影響因素以及之間的相互關系。所有分析過程使用SAS9.2和AMOS17.0軟件完成。結(jié)果:2010-2014年間,在天津市糖尿病患者中,多數(shù)患者的并發(fā)癥數(shù)量超過1種,并發(fā)癥中冠心病最為常見。居民患者的并發(fā)癥發(fā)生比例低于職工�；颊咦≡嘿M用中,來自藥品比例最高,約占總費用的一半,其次比例較高的是檢查費和治療費。居民患者的費用普遍少于職工。5年中住院費用連續(xù)增長。并發(fā)癥數(shù)量對住院費用的升高有明顯提升作用。與微血管病變相比,大血管并發(fā)癥更容易增加患者的醫(yī)療費用,而醫(yī)院等級是增加住院費用最直接的因素,三級醫(yī)院住院費最高,年齡越大的患者,男性患者以及職工的糖尿病患者費用更高。合并不同并發(fā)癥類型的糖尿病患者,會選擇不同的醫(yī)院住院治療,而居民和職工其住院費用和影響因素之間的關系也有差異。結(jié)論:天津市2型糖尿病患者更易選擇三級醫(yī)院住院治療,且多有并發(fā)癥。居民中患者在出現(xiàn)并發(fā)癥的比例和醫(yī)療支出上普遍低于職工。此外住院費用成分不合理,主要來自藥品,檢查和費用三方面。并發(fā)癥數(shù)目和類型,醫(yī)院等級,年齡,性別與住院費用有關。居民和職工患者住院費用的影響因素不盡相同,提示決策者應根據(jù)不同的患者制定相應的醫(yī)保政策,以提高衛(wèi)生資源的利用率,降低糖尿病患者的疾病負擔。
[Abstract]:Objective: to analyze the hospitalization data of type 2 diabetes mellitus patients in Tianjin medical insurance database from 2010 to 2014, to understand the basic information and hospitalization situation of patients with diabetes mellitus, and to analyze the number and type of complications. The composition of hospitalization expenses, and then study the trend of changes in costs, as well as influencing factors, to reduce the hospitalization costs of diabetes patients and the formulation of medical insurance policy to provide theoretical support. Methods: data were collected from Tianjin medical insurance database, 50 cases were randomly selected, and 749741 cases of type 2 diabetes were selected. The basic situation of the patients and hospitalization costs were analyzed. Firstly, the hospital expenses of the staff and residents of diabetes patients and the trend of their composition were described, and then combined with the number and types of complications of different patients. The influencing factors of hospitalization expenses were analyzed by rank sum test. According to the results, the multivariate linear regression and structural equation model were used to study the influencing factors and the relationship between them. All the analysis processes were completed by SAS9.2 and AMOS17.0 software. 2010-2014. In Tianjin diabetes patients, the majority of patients have more than one kind of complications, coronary heart disease is the most common complication. The incidence of complications in residents is lower than that of workers. The highest proportion comes from drugs, accounting for about half of the total cost. The next higher proportion is the examination fee and the treatment fee. The resident patient's expense is generally less than the worker. In 5 years the hospitalization expense increases continuously. The complication quantity has the obvious enhancement function to the hospitalization expense. Than. Macrovascular complications are more likely to increase the patient's medical costs, and hospital level is the most direct factor to increase the cost of hospitalization, tertiary hospital hospitalization fee is the highest, the older the patients. Male patients, as well as workers with diabetes, are more expensive. Patients with diabetes with different types of complications will choose different hospital hospitalizations. There are also differences between residents and workers in the relationship between hospitalization costs and influencing factors. Conclusion: type 2 diabetes patients in Tianjin are more likely to choose hospitalization treatment in tertiary hospitals. And there are more complications. Patients in the proportion of complications and medical expenses are generally lower than the staff. In addition, the composition of hospital expenses is unreasonable, mainly from drugs. The number and type of complications, hospital grade, age and gender were related to the cost of hospitalization. The influencing factors of hospitalization expenses of residents and workers were different. It is suggested that the decision makers should make corresponding medical insurance policies according to different patients in order to increase the utilization rate of health resources and reduce the disease burden of patients with diabetes mellitus.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R197.3;R587.1

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