本文選題：癌癥 + 發(fā)病率��； 參考：《山東大學》2017年碩士論文

【摘要】：研究目的隨著人口的增長,老齡化的加劇,人們生活方式的改變,癌癥已經(jīng)成為嚴重威脅人類健康和發(fā)展的重大疾病之一。不斷增加的癌癥患者,意味著不斷增長的衛(wèi)生服務(wù)需求,給整個社會和患者家庭帶來了極大的經(jīng)濟負擔。本研究利用2011-2013年山東省五個縣的腫瘤登記報告和當?shù)乜h醫(yī)院住院患者住院病歷信息和住院費用數(shù)據(jù)了解五縣四種常見癌癥(肺癌、胃癌、腸癌、乳腺癌(女))患者發(fā)病和住院服務(wù)利用情況,并分析影響住院天數(shù)和住院費用的影響因素。為制定有效的癌癥防治策略,優(yōu)化資源配置,控制住院費用提供參考依據(jù)。研究方法本研究根據(jù)是否開展腫瘤登記工作、地理位置分布、經(jīng)濟發(fā)展水平等因素選擇了山東省五個縣作為研究地區(qū),從五個地區(qū)分別收集四種癌癥2011-2013年的腫瘤登記報告;然后,根據(jù)腫瘤登記報告中的信息在該地區(qū)患者主要就診的縣醫(yī)院收集住院病歷信息和住院費用信息。根據(jù)腫瘤登記報告信息,計算各地區(qū)四種癌癥發(fā)病率,并對四種癌癥患者的一般特征、醫(yī)療付費方式、臨床分期、職業(yè)類型、死亡報告情況等進行描述性分析。通過將住院病歷信息和住院費用信息相結(jié)合,分析住院患者的一般情況以及住院天數(shù)和住院費用。用非參數(shù)檢驗對住院天數(shù)和住院費用進行單因素分析;在單因素分析的基礎(chǔ)上,將住院天數(shù)和住院費用進行對數(shù)轉(zhuǎn)換,采用廣義線性模型進行多因素分析。所有數(shù)據(jù)在Excel中進行整理和校對,用SPSS 18.0統(tǒng)計軟件進行分析。研究結(jié)果(1)山東省五縣四種癌癥發(fā)病率從高到低分別為肺癌63.89/10萬、胃癌50.34/10萬、乳腺癌37.40/10萬、腸癌22.10/10萬。2011-2013年總體呈現(xiàn)上升趨勢。除乳腺癌(女)外,其余三種癌癥男性發(fā)病率高于女性。乳腺癌發(fā)病比例最高的年齡段為45-59歲,其余三種癌癥發(fā)病比例最高的年齡段為60-74歲。肺癌患者處于Ⅳ期的比例最高,胃癌、腸癌患者患病人數(shù)最多的是Ⅱ、Ⅲ期,乳腺癌患者確診時超過一半的患者處于Ⅱ期。截至到調(diào)查時,肺癌患者死亡比例最高,超過70%,其次為胃癌,死亡比例超過60%;腸癌死亡比例約為40%,乳腺癌最低,約為18%。(2)五縣所有癌癥患者在當?shù)乜h醫(yī)院的人均住院總費用為23575.4元,平均住院天數(shù)為29.01天,其中腸癌患者人均住院費用最高,達到25909.1元。肥城市四種癌癥住院患者人均住院費用26248.46元,人均自付費用10162.84元,總體報銷比例為58.81%,人均住院天數(shù)為37.84天;其中人均住院費用最高的是乳腺癌,為33377.5元。臨朐縣四種癌癥患者人均住院費用22000.87元,人均住院天數(shù)為22.31天;其中人均住院費用最高的是乳腺癌,為25968.18元。乳山市四種癌癥患者人均住院費用27630.02元,人均住院天數(shù)為43.93天;人均住院費用最高的是腸癌,為28957.99元。汶上縣四種癌癥患者人均住院費用12820.33元,人均住院天數(shù)為18.27天;其中人均住院費用最高的是胃癌,為15766.99元。牟平區(qū)四種癌癥患者人均住院費用23748.29元,人均住院天數(shù)為23.80天,其中最低的是肺癌,為20831.84元。(3)五縣四種癌癥患者住院天數(shù)的影響因素:地區(qū)、癌癥類型、確診時間、"是否手術(shù)"、"是否化療"、"是否放療"、臨床分期是五縣四種癌癥患者住院天數(shù)的影響因素。乳山和肥城、乳腺癌、2012年確診、手術(shù)治療、化療治療、放療治療、Ⅲ期、年齡越小的患者住院天數(shù)越長。對五縣分別進行多因素分析,結(jié)果顯示,"是否手術(shù)"是五個縣住院天數(shù)的共同影響因素,手術(shù)患者的住院天數(shù)要多于非手術(shù)患者;"是否化療"是肥城、臨朐、乳山患者住院天數(shù)的影響因素,化療患者的住院天數(shù)要多于非化療患者;"是否放療"是肥城和臨朐癌癥患者住院天數(shù)的影響因素,放療患者的住院天數(shù)要多于非放療患者;肥城、臨朐和牟平地區(qū),患者年齡越小,住院天數(shù)越長;確診時間是影響肥城、乳山、汶上患者住院天數(shù)的因素;醫(yī)療付費方式影響乳山患者住院天數(shù),城鎮(zhèn)職工基本醫(yī)療保險和城鎮(zhèn)居民基本醫(yī)療保險患者的住院天數(shù)要高于新型農(nóng)村合作醫(yī)療和其他付費方式的患者。(4)五縣四種癌癥患者住院費用的影響因素:地區(qū)、癌癥類型、確診年份、"是否手術(shù)"、臨床分期、住院天數(shù)和年齡是五縣所有患者住院費用的影響因素。臨朐、胃癌和腸癌、2013年確診、手術(shù)治療、Ⅱ、Ⅲ期、住院時間越長、年齡越小的患者住院費用高。五縣分別進行分析,結(jié)果顯示,住院天數(shù)和"是否手術(shù)"是五個縣患者住院費用的共同影響因素,住院天數(shù)越長,手術(shù)治療的患者住院費用越高。癌癥類型是影響臨朐、乳山、汶上、牟平住院患者住院費用的因素;"是否化療"是臨朐、汶上患者住院費用的影響因素,化療患者住院費用高于未化療患者;"是否放療"是肥城患者住院費用的影響因素;確診時間對肥城和乳山患者住院費用有影響;年齡對牟平患者住院費用有影響,年齡越小,住院費用越高;臨床分期對乳山患者住院費用有影響,Ⅱ、Ⅲ期住院費用相對較高;臨朐縣患者住院費用還受到醫(yī)療付費方式的影響,城鎮(zhèn)職工基本醫(yī)療保險患者的住院費用高于城鎮(zhèn)居民基本醫(yī)療保險和新型農(nóng)村合作醫(yī)療患者。結(jié)論山東省農(nóng)村癌癥發(fā)病水平較高,肺癌和胃癌粗發(fā)病率高于全國平均水平,四種癌癥中除乳腺癌外,男性發(fā)病率均高于女性。乳腺癌平均發(fā)病年齡低于其他三種癌癥。應(yīng)積極開展健康教育,推進癌癥防治工作,減少或延緩癌癥的發(fā)生。針對重點高發(fā)癌癥,繼續(xù)開展篩查及早診早治工作,并擴大覆蓋范圍,不斷提高篩查技術(shù)和診療技術(shù),以便早發(fā)現(xiàn)、早診斷、早治療。癌癥患者住院醫(yī)療費用是其經(jīng)濟負擔的主要組成部分,可以通過開展臨床路徑,規(guī)范診療過程,提高醫(yī)療質(zhì)量,同時縮短不合理的住院天數(shù),減少不合理的資源浪費,達到控制醫(yī)療費用,提升醫(yī)院醫(yī)療服務(wù)水平和管理水平的目的。同時加快醫(yī)療保險制度改革,落實重大疾病保障政策,提高疾病報銷比例,同時加強對醫(yī)療服務(wù)過程的監(jiān)督,保證醫(yī)療保險基金充分發(fā)揮作用。
[Abstract]:With the growth of the population, the intensification of aging and the change of people's lifestyles, cancer has become one of the major diseases that seriously threaten the health and development of human beings. The increasing number of cancer patients means a growing demand for health services, which has brought great financial burden to the whole society and the family. The incidence and hospital service utilization of four common cancers (lung, stomach, colon, breast cancer) in five counties were studied in five counties of Shandong province and the data of inpatient records and hospitalization expenses in the local county hospitals, and the factors affecting the number of hospitalization days and hospitalization costs were analyzed. Effective cancer prevention and control strategy, optimization of resource allocation, and control of hospitalization costs provide reference basis. Based on the study of whether to carry out tumor registration, geographical distribution, economic development level and other factors, five counties in Shandong province were selected as research areas, and four kinds of cancer for 2011-2013 years were collected from five regions. And then, according to the information of the tumor registration report, the medical records and hospitalization expenses are collected in the county hospital which is the main patient in the area. According to the information of the registration report of the tumor, the four kinds of cancer incidence in each area are calculated, and the general characteristics of the four cancer patients, the medical payment method, the clinical stage, the occupational type, and the death are dead. A descriptive analysis was carried out on the situation of the death report. By combining the information of hospitalization records with the information of hospitalization expenses, the general situation of hospitalized patients, the days of hospitalization and the cost of hospitalization were analyzed. A single factor analysis was carried out on the days of hospitalization and the cost of hospitalization by nonparametric tests. On the basis of single factor analysis, the number of hospitalization days and hospitalization costs were entered. The multifactor analysis was carried out with the generalized linear model. All data were collated and proofread in Excel and analyzed with SPSS 18 statistical software. Results (1) four kinds of cancer incidence in five counties of Shandong province were from high to low, respectively, 63.89/10 million lung cancer, gastric cancer 50.34 /10 million, breast cancer 37.40/10 million, and colorectal cancer 22.10/10 million.2011-201 In addition to breast cancer (female), the incidence of the other three kinds of cancer men was higher than that of women. The highest incidence of breast cancer was 45-59 years old and the highest proportion of the other three cancers was 60-74 years. The highest proportion of lung cancer patients was in stage IV, and the number of cancer patients was the most in gastric cancer and colon cancer patients. In the period, more than half of the patients in the diagnosis of breast cancer were in stage II. By the time of the investigation, the death rate of lung cancer patients was the highest, more than 70%, the second was gastric cancer, the proportion of death was over 60%, the proportion of cancer death was 40%, and the lowest in the breast cancer, about 18%. (2) five county cancer patients in the local county hospital with the total cost of 23575.4 yuan per capita in the local county hospital. The average hospitalization days were 29.01 days, of which the per capita hospitalization cost of colorectal cancer patients was the highest, reaching 25909.1 yuan. The average per capita hospitalization cost of four kinds of cancer patients in Feicheng was 26248.46 yuan, the per capita self payment was 10162.84 yuan, the total reimbursement rate was 58.81%, the per capita hospitalization day was 37.84 days, and the highest per capita hospitalization expenses was breast cancer, 33377.5. Yuan. The per capita hospitalization cost of four cancer patients in Linqu county was 22000.87 yuan, and the per capita hospitalization days was 22.31 days. The highest per capita hospitalization cost was breast cancer, which was 25968.18 yuan. The per capita hospitalization expenses of four kinds of cancer patients in Rushan were 27630.02 yuan, the per capita hospitalization days were 43.93 days, and the highest per capita hospitalization cost was 28957.99 yuan. The per capita hospitalization cost of four cancer patients in the county was 12820.33 yuan, and the per capita hospitalization days was 18.27 days. The highest per capita hospitalization cost was stomach cancer, which was 15766.99 yuan. The per capita hospitalization cost of four cancer patients in Muping district was 23748.29 yuan, and the per capita hospitalization days was 23.80 days. The lowest was lung cancer, 20831.84 yuan. (3) five counties and four cancer patients were hospitalized. Factors affecting the number of days: area, type of cancer, time of diagnosis, "surgery", "whether chemotherapy", "whether radiotherapy", and clinical staging are the factors affecting the number of days in hospital in five counties. Rushan and Feicheng, breast cancer, surgical treatment, chemotherapy, radiotherapy, stage III, and the younger, the longer the days of hospitalization. To five The county was analyzed by multiple factors. The results showed that "whether surgery" was a common factor in the number of days in the five counties, and the number of hospitalized days was more than those of non operative patients. "Whether chemotherapy" was the influence factor of the days of hospitalization in Feicheng, Linqu and Rushan, the number of hospitalized days in patients with chemotherapy was more than that of non chemotherapy patients; "whether radiotherapy" is fertilizer or not is fertilizer. The factors affecting the number of hospitalized days in city and Linqu cancer patients, the number of hospitalized days in patients with radiotherapy is more than that of non radiotherapy patients; in Feicheng, Linqu and Muping, the younger the age, the longer the days of hospitalization; the time of diagnosis is the factor affecting the number of days in the hospital in Feicheng, Rushan, and Wenshang; the medical pay affects the days of hospitalization of Rushan patients and the town position. The number of hospitalization days of basic medical insurance and basic medical insurance for urban residents should be higher than those of new rural cooperative medical care and other payment methods. (4) the factors affecting the hospitalization expenses of four kinds of cancer patients in five counties: area, type of cancer, year of diagnosis, "operation", clinical stages, days of hospitalization and age of all patients in five counties The influencing factors of hospitalization expenses. Linqu, gastric cancer and colon cancer, diagnosis in 2013, surgical treatment, stage II, stage III, the longer the hospitalization time, the higher the hospitalization cost of the younger patients. The five counties were analyzed respectively. The results showed that the number of hospitalization days and "whether operation" were the common factors of the hospitalization expenses of the five county patients, the longer the hospital days were, the surgical treatment was treated. The higher the cost of hospitalization for the patients. The cancer type is the factor affecting the hospitalization expenses in Linqu, Rushan, Wenshang and Muping. "Whether chemotherapy" is the influencing factor of the hospitalization expenses of the patients in Linqu and Wenshang, the hospitalization expenses of the chemotherapy patients are higher than those of the non chemotherapy patients; "whether the radiotherapy" is the influencing factor of the hospitalization expenses of the Feicheng patients; the time for the diagnosis is Feicheng and the diagnosis of the hospital. The hospitalization expenses of the patients in Rushan have an impact; the age has an impact on the hospitalization expenses of the patients in Muping, the younger the age and the higher the cost of hospitalization; the clinical stages have an impact on the hospitalization expenses of the patients in Rushan, and the cost of the hospitalization of the patients in the stage II is relatively high; the hospitalization expenses of the patients in Linqu county are also affected by the way of medical payment, and the residents of the basic medical insurance for urban workers live. The hospital cost is higher than the basic medical insurance of urban residents and the new rural cooperative medical patients. Conclusion the incidence of cancer in rural areas in Shandong is higher, the incidence of lung cancer and gastric cancer is higher than the national average. In addition to breast cancer in four kinds of cancers, the incidence of male is higher than that of women. The average age of breast cancer is lower than that of other three kinds of cancer. To carry out health education, promote cancer prevention and control, reduce or delay the occurrence of cancer. In order to focus on high incidence of cancer, continue screening and early diagnosis and treatment, and expand coverage, constantly improve screening technology and diagnosis and treatment technology, so that early detection, early diagnosis and treatment are the main economic burden of cancer patients. In the component part, we can carry out the clinical path, standardize the diagnosis and treatment process, improve the medical quality, shorten the irrational hospital days, reduce the irrational waste of resources, control the medical expenses, improve the medical service level and management level of the hospital, and accelerate the medical insurance system reform and implement the major disease guarantee policy. We should improve the proportion of reimbursement for diseases, strengthen supervision over the medical service process, and ensure the full play of medical insurance funds.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R73-31

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4 李策;大連市某縣級醫(yī)院住院費用及其影響因素研究[D];大連醫(yī)科大學;2013年

5 李春婷;山東省某三級甲等醫(yī)院住院費用分析[D];山東大學;2009年

6 郝娟;同級別醫(yī)院住院費用影響因素研究[D];山西醫(yī)科大學;2011年

7 安豐玲;某醫(yī)院產(chǎn)婦住院費用變化趨勢及相關(guān)因素研究[D];山東大學;2009年

8 郭亞璋;湖南湘西某醫(yī)院醫(yī)保職工2003～2007年住院費用及影響因素分析[D];中南大學;2008年

9 榮惠英;基于遞歸系統(tǒng)模型的醫(yī)保住院費用影響因素研究[D];山西醫(yī)科大學;2011年

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