Analysis Of Hospitalization Expenses And Influencing Factors Among Stroke Patients In Changchun City From 2015 To 2017

Objective:This study was conducted to understand the basic characteristics of stroke inpatient cases and the composition of hospitalization expenses at all kinds of hospitals in Changchun from 2015 to 2017;to analyze the change trend of hospitalization expenses,and to explore the influencing factors of hospitalization expenses of stroke cases.As a result,the study would provide a scientific reference for promoting the prevention and treatment of stroke,strengthening the management of patients’ hospitalization expenses,promoting the reform of the medical insurance payment system,and reducing the economic burden of disease on stroke patients.Methods:We obtained data from home page of medical records of patients discharged from all kinds of hospitals in Changchun City from January 1,2015 to December 31,2017.The study was conducted on 71,125 cases with a primary diagnosis of stroke.The basic characteristics,hospitalization expense composition and the change of trends of all stroke cases and different types of stroke cases were separately described and analyzed.Comparative analysis of the basic conditions of different types of stroke hospitalization cases was used chi-square test.Gray correlation and structural variability was used to analyse the internal structure and variability trends of hospitalization expenses among stroke patients.The non-parametric test was performed to investigate the effect of demographic characteristics and admission status on hospitalization expenses.Multiple linear regression was used to explore the factors influencing hospitalization expenses in all stroke cases and different types of stroke cases,respectively.Results:(1)Stroke inpatients in Changchun City accounted for a higher percentage of males(62.51%)than females(37.49%)with an average age of 64.07±11.86 years.There were more ischemic stroke patients(85.74%)than hemorrhagic stroke patients(14.26%).Hemorrhagic stroke patients had the highest percentage of inpatient cases aged 45-64 years(55.16%)with an average age of 59.33±12.98 years;while ischemic stroke patients aged 65 years and above had the highest percentage(51.28%)with an average age of 64.86±11.48 years old.(2)The hospitalization expense of stroke patients in Changchun was much higher in 2015-2017.The average hospitalization expense of total stroke cases was 13,365.68 yuan,with a median of 7429.53 yuan.The average hospitalization expense of hemorrhagic stroke patients was 33,383.01 yuan,with a median of 16,296.21 yuan;the average hospitalization expense of ischemic stroke was 10,036.63 yuan,with a median of 6919.25 yuan,and the hospitalization expense for hemorrhagic stroke was higher than ischemic stroke(P <0.05).The overall trend of hospitalization expenses for stroke patients was increasing,with median hospitalization expenses growing by 3.61% and14.85% year-on-year in 2016 and 2017,respectively.(3)In the composition of stroke patients’ inpatient expenses,drug expenses accounted for a higher proportion,but displayed a slight downward trend(37.61%,37.46% and 30.97% from 2015 to 2017)respectively.The proportion of comprehensive medical service expenses,diagnostic expenses and treatment expenses decreased year by year,while the proportion of consumables as well as blood and blood products expenses increased slightly year by year.In addition,the proportion of ischemic stroke drugs(37.78%)was higher than hemorrhagic stroke drugs(27.46%).(4)As shown in the gray correlation analysis,the most significant contribution to inpatient expenses for total stroke cases was drug expenses,whether for hemorrhagic stroke cases or ischemic stroke cases,with correlations of 1.000,0.9589,1.000,respectively.Structural variability analysis showed that the top three contributors to the structural change in total stroke cases,excluding other expenses,were comprehensive medical service expenses(22.91%),drug expenses,(12.62%),and consumable expenses(12.21%)during the period of 2015 to 2017.The top three contributors to the structural change among hemorrhagic stroke cases were comprehensive medical service expenses(25.79%),consumable expenses(12.20%),and treatment expenses(11.72%).The top three contributors to the structural change in ischemic stroke cases were comprehensive medical service expenses(27.32%),followed by drug expenses(15.60%)and consumable expenses(12.54%).(5)Multiple linear regression results showed that the influencing factors of the hospitalization expense of total stroke cases were,in order,the number of days of hospitalization,whether surgery was performed,the presence of comorbidities,whether ICU,type of stroke,year,whether transferred,whether coma,whether allergy,ethnicity,age,gender,and number of hospitalizations(P<0.05).The largest effect on hospitalization expense for hemorrhagic stroke cases was whether surgery was performed,followed by days of hospitalization,whether ICU,presence of comorbidities,whether coma,year,gender,number of hospitalizations,whether transferred,and age(P<0.05).The most influential factor on the hospitalization expense of ischemic stroke cases was the number of days of hospitalization,and the others were,in order,whether surgery,presence of comorbidities,whether ICU,year,whether transfer,whether allergy,gender,ethnicity,whether coma,number of hospitalizations,and age(P <0.05).Conclusions:(1)Stroke patients in Changchun have a high economic burden of disease in 2015-2017.The hemorrhagic stroke accounts for a small percentage of stroke,however,the mean hospitalization expense was significantly higher than the ischemic stroke.It is necessary to strengthen stroke screening and health education,as well as improve tertiary prevention,and highlight the role of primary care institutions in stroke prevention and treatment.(2)The structure of inpatient stroke costs is composed of a relatively low proportion of technical and labor costs,and the costs of drugs,comprehensive medical services,consumables,and treatment have a greater impact on the internal structure of inpatient stroke costs.Therefore,it is necessary to optimize the structure of hospitalization costs,and to increase the technical and labor costs of stroke patients reasonably.(3)Hospitalization days and surgery are the main factors that jointly affected the hospitalization expense of hemorrhagic stroke and ischemic stroke.The factors such as whether ICU,presence of comorbidities,whether coma,year,gender,number of hospitalizations,whether transferring to other departments,and age also affected the hospitalization expense of different types of stroke patients in different degrees.We need to guide patients to seek reasonable medical treatment,improve the standardized treatment and disease management model of stroke,normalize the clinical pathway of stroke,strengthen the information management of stroke disease,and shorten the number of days of hospitalization for stroke patients to reduce inpatient hospitalization expense.