糖尿病足患者住院費(fèi)用變化趨勢及影響因素分析
發(fā)布時間：2018-07-16 19:05
【摘要】：目的:分析2002年~2013年糖尿病足(Diabetic foot,DF)患者住院費(fèi)用的變化趨勢及各項(xiàng)費(fèi)用的構(gòu)成比例,分析影響糖尿病足患者住院費(fèi)用的因素,為進(jìn)一步大規(guī)模流行病學(xué)研究、及時發(fā)現(xiàn)糖尿病足高危人群、有效預(yù)防和早期治療糖尿病足、改善患者生活質(zhì)量從而減少糖尿病足相關(guān)醫(yī)療支出提供依據(jù),為國家、醫(yī)保、個人減輕醫(yī)藥費(fèi)用開支探索出新的途徑。方法:1.研究對象選取2002年1月至2013年12月期間在天津醫(yī)科大學(xué)代謝病醫(yī)院足科住院的糖尿病(Diabetes Mellitus,DM)合并DF患者,依據(jù)入選與排除標(biāo)準(zhǔn),共計(jì)1575例患者納入研究。2.將12年的病人按每3年為一組平均分為A、B、C、D4組,比較4組間住院總費(fèi)用的變化趨勢及各項(xiàng)分費(fèi)用的構(gòu)成趨勢。3.將患者的一般情況、足局部情況、糖尿病并發(fā)癥及合并癥情況及手術(shù)情況進(jìn)行分層,比較各項(xiàng)目分層后住院費(fèi)用的差別。4.采用多元線性回歸分析進(jìn)一步探討住院費(fèi)用及住院天數(shù)的影響因素并對其進(jìn)行相關(guān)性檢驗(yàn)。結(jié)果:1.1575例患者中,男性992例,女性583例,年齡范圍21~91歲,平均年齡66±11歲,DM病程范圍半年~40年,中位時間11.5年,DF病程范圍1~417周,中位時間5周。2.A、B、C、D四組住院費(fèi)用呈上升趨勢,D組增長最快;住院天數(shù)有一些波動,但總體上呈下降趨勢。3.四組間藥費(fèi)在總費(fèi)用中的比重最大,呈較平緩的上漲趨勢;檢查費(fèi)、手術(shù)費(fèi)、一般治療操作費(fèi)和一次性材料費(fèi)均呈上升趨勢,且在總費(fèi)用中所占的比例也逐漸上漲;一般醫(yī)療服務(wù)費(fèi)和護(hù)理費(fèi)有一些波動,但總體水平呈下降趨勢,與住院天數(shù)逐漸縮短一致;其他費(fèi)在四組間呈小幅上漲。除一般醫(yī)療服務(wù)費(fèi)外,四組間各項(xiàng)費(fèi)用均有顯著差異(P0.05)。4.單因素分析中,年齡、糖尿病病程、潰瘍病程、Hb A1c、Wagner分級、ABI、感染致病菌個數(shù)、眼部疾病、糖尿病腎病、高血壓病、并發(fā)癥及合并癥個數(shù)及手術(shù)方式12個變量的住院費(fèi)用差異有統(tǒng)計(jì)學(xué)意義。年齡、Hb A1c、Wagner分級、ABI、致病菌個數(shù)、腦血管疾病、眼部疾病、糖尿病腎病、血脂異常、并發(fā)癥及合并癥個數(shù)及手術(shù)方式11個變量的住院天數(shù)差異有統(tǒng)計(jì)學(xué)意義。5.多因素分析中,年齡、住院天數(shù)、潰瘍病程、Wagner分級、ABI、致病菌個數(shù)、高血壓病、并發(fā)癥及合并癥個數(shù)和手術(shù)方式進(jìn)入住院費(fèi)用的回歸模型中。年齡、Hb A1c、Wagner分級、ABI、并發(fā)癥及合并癥個數(shù)、手術(shù)方式進(jìn)入住院天數(shù)的回歸模式。6.住院費(fèi)用與住院天數(shù)的相關(guān)性檢驗(yàn)中,Spearman相關(guān)系數(shù)為0.856,P=0.0000.05,結(jié)果有顯著性,住院費(fèi)用與住院天數(shù)呈正相關(guān)。結(jié)論:DF住院費(fèi)用巨大,且呈上漲趨勢,其中以藥費(fèi)所占比例最大。不同臨床特征的DF,住院費(fèi)用有很大不同。年齡、潰瘍病程、Hb A1c、住院天數(shù)、Wagner分級、ABI、感染致病菌個數(shù)、高血壓病、并發(fā)癥及合并癥個數(shù)及手術(shù)情況是影響住院費(fèi)用的獨(dú)立因素。其中,年齡、Wagner分級、ABI、并發(fā)癥及合并癥個數(shù)、手術(shù)情況既可以直接影響住院費(fèi)用,又可以通過住院天數(shù)間接影響住院費(fèi)用;潰瘍病程、感染致病菌個數(shù)及高血壓病直接影響住院費(fèi)用;Hb A1c通過住院天數(shù)間接影響住院費(fèi)用。加強(qiáng)足病教育宣傳,定期檢查DM患者足病變的危險因素并及時矯正,能顯著降低DF的發(fā)生率和降低有關(guān)費(fèi)用。
[Abstract]:Objective: to analyze the change trend of hospitalization expenses for patients with Diabetic foot (DF) in 2002 ~2013 and the proportion of various expenses, analyze the factors that affect the hospitalization expenses of diabetic foot patients, and to find out the high risk population of diabetic foot in time for further large-scale epidemiological study, and improve the effective prevention and early treatment of diabetic foot. The quality of life to reduce diabetic foot related medical expenditure provides a basis for the state, medical insurance, and individuals to reduce the cost of medical expenses to explore a new way. 1. subjects selected from January 2002 to December 2013 in the Medical University Of Tianjin metabolic hospital foot hospital diabetes (Diabetes Mellitus, DM) combined DF patients, According to the criteria of admission and exclusion, a total of 1575 patients were included in the study.2. for 12 years in a group of 3 years as an average of A, B, C, D4, and compared the trend of the total cost of hospitalization between the 4 groups and the trend of the composition of the expenses. The general condition, the foot local condition, the diabetic complication and the complication and the operation situation were carried out. The difference of hospitalization expenses after stratification of each item.4. was analyzed by multiple linear regression analysis to further explore the influencing factors of hospitalization costs and days of hospitalization. Results: among the 1.1575 patients, 992 were male, 583 women, age 21~91 years, the average age was 66 + 11 years, and the range of DM course was half a year ~40 years. The duration of 11.5 years was 11.5 years, the course range was 1~417 weeks, the median time was 5 weeks.2.A, the four groups of B, C, and D were on the rise, the D group grew fastest, the number of hospitalization days had some fluctuations, but the overall decline trend was the largest proportion in the total cost in the total cost of the.3. four, and the cost of inspection, operation, general treatment and one time. The cost of sex material increased, and the proportion of the total cost increased gradually; the general medical service fee and nursing charge had some fluctuations, but the overall level showed a downward trend, and the number of hospitalization days decreased gradually. The other fees were slightly higher among the four groups. Except for the general medical service charge, the expenses of the four groups were significantly different ( P0.05) in.4. single factor analysis, age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, ocular diseases, diabetic nephropathy, hypertension, complications and the number of complications and surgical methods were statistically significant. Age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, brain blood There were significant differences in the number of hospitalization days between 11 variables, tube disease, ocular disease, diabetic nephropathy, dyslipidemia, complications, complications, complications, complications and surgical methods. Age, days of hospitalization, course of ulcers, Wagner classification, ABI, number of pathogenic bacteria, hypertension, complications and complications and complications and surgical methods entered the hospital. The regression model of the cost. Age, Hb A1c, Wagner classification, ABI, complications and complication, the operation mode entered the hospitalization days, the correlation of.6. hospitalization expenses and hospital days was 0.856, P=0.0000.05, the result was significant, the hospitalization cost was positively related to the hospital days. Conclusion: DF hospitalization fee. There was a huge and rising trend, with the largest proportion of drug charges. DF with different clinical features was very different. Age, the course of the ulcer, the Hb A1c, the number of days of hospitalization, the Wagner grade, the ABI, the number of pathogenic bacteria, the hypertension, the complication and the number of complications and the operation were the independent factors of the hospitalization expenses. Wagner classification, ABI, complications and complications, the operation can directly affect the cost of hospitalization, but also indirectly affect hospitalization expenses through the days of hospitalization; the course of ulcers, the number of infection pathogenic bacteria and hypertension directly affect the hospitalization expenses; Hb A1c indirectly affects hospitalization expenses through the number of days in hospital. Checking the risk factors and timely correction of foot lesions in DM patients can significantly reduce the incidence of DF and reduce the related costs.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2
本文編號：2127381
[Abstract]:Objective: to analyze the change trend of hospitalization expenses for patients with Diabetic foot (DF) in 2002 ~2013 and the proportion of various expenses, analyze the factors that affect the hospitalization expenses of diabetic foot patients, and to find out the high risk population of diabetic foot in time for further large-scale epidemiological study, and improve the effective prevention and early treatment of diabetic foot. The quality of life to reduce diabetic foot related medical expenditure provides a basis for the state, medical insurance, and individuals to reduce the cost of medical expenses to explore a new way. 1. subjects selected from January 2002 to December 2013 in the Medical University Of Tianjin metabolic hospital foot hospital diabetes (Diabetes Mellitus, DM) combined DF patients, According to the criteria of admission and exclusion, a total of 1575 patients were included in the study.2. for 12 years in a group of 3 years as an average of A, B, C, D4, and compared the trend of the total cost of hospitalization between the 4 groups and the trend of the composition of the expenses. The general condition, the foot local condition, the diabetic complication and the complication and the operation situation were carried out. The difference of hospitalization expenses after stratification of each item.4. was analyzed by multiple linear regression analysis to further explore the influencing factors of hospitalization costs and days of hospitalization. Results: among the 1.1575 patients, 992 were male, 583 women, age 21~91 years, the average age was 66 + 11 years, and the range of DM course was half a year ~40 years. The duration of 11.5 years was 11.5 years, the course range was 1~417 weeks, the median time was 5 weeks.2.A, the four groups of B, C, and D were on the rise, the D group grew fastest, the number of hospitalization days had some fluctuations, but the overall decline trend was the largest proportion in the total cost in the total cost of the.3. four, and the cost of inspection, operation, general treatment and one time. The cost of sex material increased, and the proportion of the total cost increased gradually; the general medical service fee and nursing charge had some fluctuations, but the overall level showed a downward trend, and the number of hospitalization days decreased gradually. The other fees were slightly higher among the four groups. Except for the general medical service charge, the expenses of the four groups were significantly different ( P0.05) in.4. single factor analysis, age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, ocular diseases, diabetic nephropathy, hypertension, complications and the number of complications and surgical methods were statistically significant. Age, Hb A1c, Wagner classification, ABI, the number of pathogenic bacteria, brain blood There were significant differences in the number of hospitalization days between 11 variables, tube disease, ocular disease, diabetic nephropathy, dyslipidemia, complications, complications, complications, complications and surgical methods. Age, days of hospitalization, course of ulcers, Wagner classification, ABI, number of pathogenic bacteria, hypertension, complications and complications and complications and surgical methods entered the hospital. The regression model of the cost. Age, Hb A1c, Wagner classification, ABI, complications and complication, the operation mode entered the hospitalization days, the correlation of.6. hospitalization expenses and hospital days was 0.856, P=0.0000.05, the result was significant, the hospitalization cost was positively related to the hospital days. Conclusion: DF hospitalization fee. There was a huge and rising trend, with the largest proportion of drug charges. DF with different clinical features was very different. Age, the course of the ulcer, the Hb A1c, the number of days of hospitalization, the Wagner grade, the ABI, the number of pathogenic bacteria, the hypertension, the complication and the number of complications and the operation were the independent factors of the hospitalization expenses. Wagner classification, ABI, complications and complications, the operation can directly affect the cost of hospitalization, but also indirectly affect hospitalization expenses through the days of hospitalization; the course of ulcers, the number of infection pathogenic bacteria and hypertension directly affect the hospitalization expenses; Hb A1c indirectly affects hospitalization expenses through the number of days in hospital. Checking the risk factors and timely correction of foot lesions in DM patients can significantly reduce the incidence of DF and reduce the related costs.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 閻玉霞;;住院病人92674例住院費(fèi)用的影響因素分析[J];第一軍醫(yī)大學(xué)分校學(xué)報(bào);2005年02期
，本文編號：2127381
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