Study On Influencing Factors And Case-mix Of Hospitalization Expenses For Inpatient Early Rehabilitation Of Stroke

Background:Stroke is the leading cause of death and disability among adults in China.Timely early rehabilitation therapy can effectively improve the functional prognosis of stroke patients.The high-quality development of rehabilitation services requires support from medical insurance funds,and the incomplete medical insurance payment system has become an important constraint on the development of early stroke rehabilitation services.Currently.China is implementing a multi-component medical insurance payment method primarily based on diagnosis-related group(DRG),encouraging exploration of payment based on bed-days for long-term rehabilitation hospitalization.However,the currently determined basic bed-day rates in different regions have significant limitations and fail to accurately reflect the costs.The exploration of a case-mix-based medical insurance payment system is a common research focus both domestically and internationally.Objective:To understand the composition of hospitalization costs during the early-stage rehabilitation phase of stroke and further exploring the factors influencing the average daily total cost,as well as the average daily medical costs,average daily rehabilitation costs,and average daily nursing costs during this phase.Constructing a case-mix model for bed-day costs of early-stage stroke rehabilitation,aiming to provide insights for the reform of medical insurance payment systems in early-stage stroke rehabilitation.Methods:Literature review method and expert consultation method were used to understand the theoretical research progress of clinical treatment and cost control in the field of early stroke rehabilitation,and the research experience of influencing factors and case portfolio of stroke rehabilitation hospitalization costs at home and abroad was collected.Non-parametric test and multiple linear stepwise regression analysis were used to analyze the influencing factors of average daily hospitalization cost in early stroke rehabilitation stage.The classification and regression tree(CART)was used to construct the case-mix model of daily cost of early stroke rehabilitation.RIV and CV were used to verify the model.Results:1.The average total hospitalization cost of early stroke rehabilitation was 15072.09 ±8865.98 yuan,and the average daily total hospitalization cost was 1202.30±1232.30 yuan.Among the total expenses,medical expenses accounted for 75.73%,rehabilitation expenses accounted for 13.01%and nursing expenses accounted for 7.01%.Among the rehabilitation expenes,TCM rehabilitation expenses and physical therapy expenses accounted for the highest proportion,47.87%and 42.18%,while speech therapy and occupational therapy expenses accounted for relatively less,5.71%and 4.23%.2.The main factors affecting the average daily hospitalization cost were the level of medical institution,age,tracheotomy and ventilator use,ADL,complications,cognitive impairment,dysphagia and depression(P<0.05).The main factors affecting the average daily medical cost were tracheotomy and ventilator use,cognitive impairment,ADL,complications and dysphagia(P<0.05).The main factors affecting the average daily rehabilitation cost were ADL,dysphagia,age and complications(P<0.05).The main factors affecting daily nursing cost were cognitive impairment,complications,tracheotomy and ventilator use(P<0.05).3.Eight case-mix of total daily cost were constructed.Required variables included tracheotomy and ventilator use,cognitive impairment,complications,ADL,and age.The CV were all lower than 1,and the RIV were 55.36%.4.A case-mix model of daily bed expense was constructed with reference to PDPM,including medical service,rehabilitation service,nursing service and facility service.The CV of each part were basically less than 1,and the RIV were between 40%-60%.Conclusions:The case-mix model constructed according to the grouping idea of PDPM shows good homogeneity and variation among groups.The case-mix model can distinguish and medicine,rehabilitation and nursing services based on patient needs.Compared with the case-mix model grouped according to the average daily total cost alone,it can more accurately reflect the cost of different types of services and is more consistent with the needs of early rehabilitation.