Shandong Province Acute Myeloid Leukemia Hospitalization Expenses In A Teaching Hospital And Its Influencing Factors

Research background:Leukemia is a kind of malignant clonal disorder of hematopoietic stem cells. The survey found that the incidence of leukemia in different area of China accounted for sixth in a variety of tumors.Acute myeloid leukemia is the most common type of leukemia, accounted for the vast majority of patients with leukemia. On the basis of existing researches, lead to leukemia factor mainly in the following categories:1 viral factors:RNA virus induced leukemia mostly belongs to type T cells infected with leukemia.2 biochemical factors:some chemical substance can also lead to increased incidence of leukemia. Exposure to benzene compounds and derivatives of the crowd leukemia incidence was higher than that of the general population.3:there is evidence of radioactive factors, various ionizing radiation can cause the human leukemia incidence rate increase. The occurrence of leukemia in the human body depends on the absorption of radiation dose, the whole body or partial body affected by moderate doses of radiation or high doses can induce leukemia.4 genetic factors:chromosome aberration crowd leukemia incidence is higher than that of normal person. With the potential risk of industrial pollution aggravation and life of the growth factors in acute leukemia in children and adolescents, more abrupt onset, become a significant disease affecting people life quality. Due to limited understanding of the general population of leukemia and treatment there is a big pain, easy to cause the leukemia patients psychological panic. Although at present for the treatment of leukemia has made breakthrough progress, but because of the complexity of drug treatment and treatment methods, treatment costs are still high, and in a variety of medical insurance for leukemia disease reimbursement ratio is less, make the most of leukemia patients the disease economic burden has been aggravated. Most leukemia patients choose the hospital treatment, the longer course of treatment, the treatment process is complicated, but also makes the high cost of diagnosis and treatment of leukemia patients. The status of research on factors of hospitalization expenses of patients with leukemia and its effects, contribute to the understanding of the basic economic burden of patients with leukemia, take corresponding measures to reduce the length of the associated costs, reduce poverty due to illness, poverty due to illness rate, improve the quality of life of patients with leukemia. Acute promyelocytic leukemia (M3) as the inclusion of clinical pathway management of single disease disease, the hospitalization expenses and cost composition structure and whether other types of leukemia are different, but also a lot of doctors and patients to concern, research into the clinical path of white blood disease is in the in-patient cost optimization, is conducive to the promotion of the standardization of the medical behavior, improve the quality of medical treatment guarantee medical safety, at the same time, the maximum possible reduce unreasonable medical expenses.Research Objectives:Through the analysis of the status quo of leukemia related inpatient department of a teaching hospital 2012--2014 acute myeloid leukemia in hospital of Shandong Province, analysis of composition of hospitalization expenses of patients, and a detailed analysis of the influence of related factors of the patients with leukemia in hospital, analyze and verify the relevant factors, to establish and perfect the necessity and feasibility of inpatient medical expenses management and control of single disease system, in order to reduce the economic burden of patients with leukemia in hospital and put forward feasible measures. Acute promyelocytic leukemia (M3) as the inclusion of clinical pathway management of single disease disease is superior to other types of leukemia, analysis of the hospitalization expenses and cost mechanism, whether there is value to popularize.Materials and Methods:This study is a retrospective study method, in the full assurance premise of patient privacy, data filters through the hospital information management system. From January 1,2012 to 2014 screening database in December 31 day of hospitalization in patients with leukemia for. According to the classification number of medical records of hospital, random selection of discharge diagnosis code for C92.401 in acute promyelocytic leukemia (M3) cases of acute non lymphocytic leukemia cases and discharge diagnosis codes for C95.003 and acute myeloid discharge diagnosis codes for the C92.000 lineage leukemia disease cases as the investigation case. According to case selection into standards. To screen out a total of 2429 cases of acute myeloid leukemia patients. On this basis, combined with the needs of this study, the total hospital costs less than 500 yuan of patients during hospitalization and removal of non physician patients in hospital, with the final study sample of 1427 cases selected.The data entry using the Epidata software, the data were analyzed by SPSS 16.0. Descriptive analysis of 1427 cases of leukemia patients in general, using t test and chi square test for acute promyelocytic leukemia (M3) cases and other cases of leukemia compared condition, using multiple linear regression to find the factors affecting hospitalization expenses in patients with acute myeloid leukemia.Research Results:The main results of this study are as follows:1,1427 patients in this study, male patients accounted for 59.6%, more than female patients; patients age is more concentrated in middle age (41 years old to 50 years old) and young (21 years old to 30 years old) age accounted for 42.7% of the total number of patients, the number of patients; patients accounted for 70.4% of the total number of married medical insurance; patient types as the number of new rural cooperative medical care the most, accounting for 48.2% of the total number of patients; the most patient general condition on admission of patients, the total number of patients during 92.1%; patients in the nursing level to level three, the number of the most, accounting for the total number of patients in 48.8% patients with complications; for patients with complications in patients with pulmonary infection occupies 52.2%; the hospitalized days are more concentrated in under and over one week two weeks following; patients in only 82 of patients in the hospital, surgery;2, from 2012 to 2014, the upward trend of acute myeloid leukemia patients hospitalization expenses mean,2014 annulus comparing grows 11.4%, grow 12.9% compared to the same period;3, from 2012 to 2014, form acute myeloid leukemia patients hospitalization expenses, medicine charge, transfusion fee, laboratory fee, material fee, health treatment fee for the top five;4, from 2012 to 2014. Acute myeloid leukemia patients hospitalization cost elements:medicine fee, transfusion fee, laboratory fee, hygienic material fee, treatment fee, bed fee, traditional Chinese medicine fees, inspection fees, nursing fees, medical fees are rising trend;5,2012 to 2014 in patients with acute myeloid leukemia in hospital operation fee costs also rising trend, in 2014 than the 94.9% growth in 2012;6, the clinical path into the acute promyelocytic leukemia (M3) during the hospitalization, total cost, treatment, examination, nursing and various drug costs were associated with other types of leukemia are different; and the mean less than other types of leukemia;In 7, the single factor analysis showed, acute myeloid leukemia patients gender, age distribution, marital status, medical insurance type, the level of care, concurrent disease, hospitalization days, whether or not to accept the operation, hospitalization, disease category year condition is affecting acute myeloid significant factors of hospitalization expenses of patients white blood;8, multiple linear regression analysis showed that acute myeloid leukemia patients’ gender, age, insurance type, concurrent diseases, hospitalization, surgery and the type of the disease is the effect of acute medullary system comprehensive cost of significant factors in hospital patients with leukemia.Conclusions and Suggestions:1, vigorously promote the clinical pathway, regulating medical behavior, reduce the economic burden of disease of patients2, optimize the composition of hospitalization cost, expenses for medicine than control, improve the technical value of medical staff3, the optimization running of the medical insurance system, improve the compensation in hospital treatment of urban and rural insurance personnel4, the optimization of single disease payment mechanism, enhance the level of single disease medical treatment5, collaborative multi sectoral, standardizing medical behavior, improve the hospital social responsibility...