Study On Hospitalization Costs And Influencing Factors Of Patients With Acute Ischemic Stroke In A Tertiary Hospital In Gansu Province

Objective: This research was expected to understand the internal composition,changing trends and influencing factors of the hospitalization costs of patients with acute ischemic stroke(AIS)in the past 7 years,in order to provide a theoretical basis for reducing the economic burden of hospitalization for patients with AIS by means of a retrospective analysis of hospitalization costs and related clinical medical records of patients with AIS in a tertiary hospital in Gansu Province from January 1,2013 to December 31,2019.Methods: The data of this study were derived from the first page information of the medical records,some clinical medical records and hospitalization costs of patients with AIS in a tertiary hospital in Gansu Province from 2013 to 2019,and the researcher established a hospitalization costs database for patients with AIS through Excel.The researcher retrospectively analyzed the hospitalization costs,their internal structures and changing trends in the past 7 years,carried out univariate analysises among the demographic information,clinical related indicators,comorbidities,complications,and total hospitalization costs,then used multiple stepwise regression analysis to analyze the influencing factors of hospitalization costs by the multiple stepwise regression analysis method and established a Logistic regression predictive model for influencing factors of the level of hospitalization costs.Results: 1.A total of 8862 patients with AIS were included for analysises.The average hospital stays were 11.00(8.00～13.25)days.The average per-time hospitalization costs were 16,493.48(12486.18～22284.35)Yuan.The top two comorbidities are hypertension(59.9%)and diabetes(21.5%),and pulmonary infections(9.7%)accounted for the highest proportion of complications.The peaks of the two hospitalizations were in March to May and October to December.2.The average length of hospital stays decreased year by year,and the average per-time hospitalization costs and daily average hospitalization costs showed a upward trend,and the differences were statistically significant(P<0.05).The growth rate of the average per-time hospitalization costs and daily average hospitalization costs showed an overall downward trend.3.The top three internal components of hospitalization costs were drug costs(54.31%),inspection costs(15.18%)and treatment costs(11.35%),which together accounted for more than 70% of the total hospitalization costs.The proportion of drug costs decreased year by year,but it still accounted for41.56% until 2019.The proportion of treatment costs increased year by year,and the proportion of inspection costs decreased and then increased.The composition ratio of drug costs and treatment costs generally showed downward trends.The composition ratio of inspection costs decreased and then increased.4.The results of univariate analysises showed that comparison of the average per-time hospitalization costs of patients with AIS with different ages,genders,nationalities,year of admission,first visiting to the inpatient department,NIHSS scores,GCS scores,surgery,hypertension,diabetes,hyperlipidemia,atrial fibrillation,patent foramen ovale,acute myocardial infarction,liver insufficiency,renal insufficiency,pulmonary infection,urinary tract infection and phlebothrombosis of legs were statistically significant(P<0.05),whether there is no statistically significant difference in the average per-time hospitalization costs of patients with AIS with coronary atherosclerotic heart disease,hyperhomocysteinemia and cardiac insufficiency(P>0.05).5.The results of Model 1showed that the influencing factors of hospitalization costs of AIS patients were the length of hospital stays,surgery,lung infection,year of admission,first visiting to the inpatient department,atrial fibrillation,phlebothrombosis of legs,ages,acute myocardial infarction,diabetes,renal insufficiency,urinary tract infection,genders and nationalities in turn(P<0.05).The results of Model 2 showed that the influencing factors of hospitalization costs of AIS patients were the length of hospital stays,surgery,NIHSS scores,lung infection,first visiting to the inpatient department,GCS scores,ages,acute myocardial infarction,phlebothrombosis of legs,atrial fibrillation,abnormal renal function and year of admission in turn(P<0.05).6.The binary Logistic regression prediction model showed that the ages,year of admission,the length of hospital stays,abnormal renal function,acute myocardial infarction,phlebothrombosis of legs,lung infection,surgery,first visiting to the inpatient department,NIHSS scores and GCS scores were independent predictors of hospital costs in patients with AIS(P<0.05),and the model fit well.Conclusions: 1.The hospitalization costs of patients with AIS increased year by year.Although the growth rate of hospitalization costs had declined,the economic burden of hospitalization was still heavy.2.Pulmonary infection was the most common complication of patients with AIS that obviously affected hospitalization costs.Early preventions and treatments are effective ways to reduce hospitalization costs of AIS.3.Two peaks with the highest number of hospitalizations were in March to May and October to December,and it was very important to strengthen the protection of high-risk groups in the high-risk seasons of AIS.4.The drug costs was the most important factor in the internal composition of hospitalization costs,so the reduction of medicine costs was crucial to the regulation of the entire hospitalization costs.5.The length of hospital stays,surgery,lung infection,NIHSS scores,first visiting to the inpatient department,GCS scores,acute myocardial infarction,phlebothrombosis of legs,year of admission,ages,atrial fibrillation and abnormal renal function were the influencing factors of hospitalization costs for patients with AIS.