| Objectives: The purpose of this study was to understand the population characteristics,cost burden and cost composition of hospitalized patients with ischemic stroke,and to explore the factors influencing ischemic stroke hospitalization cost,so as to provide scientific evidence for the relevant departments to effectively control the hospitalization cost of ischemic stroke patients and reduce the burden on patients and their families.Methods: The data of this study were obtained from the Shanghai Statistics Center for Health,and all hospitalization records in Shanghai of ischemic stroke patients in J district from 2016 to 2019 were extracted according to the main diagnostic code “ICD-10=I63”.Use IBM SPSS 26.0,Stata MP16.0,Excel and other software to clean the data,and statistically analyze the data.Grey related analysis and degree of structure variation analysis were used to analyze the structure of hospitalization cost and the changes over the years.Nonparametric tests,multiple linear regression and quantile regression were used to analyze the influencing factors of hospitalization cost.The test level of this study is α=0.05.Results:(1)Basic situation of patients with ischemic stroke: A total of 3608 patients with ischemic stroke were included in this study.Among which,the ratio of male to female was 1:1.04,the average age was 73.86±11.32 years old,and 89.83% of the elderly patients were aged 60 and above.Inpatients in secondary hospitals accounted for 94.60%.(2)Hospitalization cost and LOS of patients with ischemic stroke:From 2016 to 2019,the median and interquartile range of total hospitalization cost of ischemic stroke patients in J district,Shanghai was9659.26(7111.74,13941.25)yuan,the median and interquartile range of daily hospitalization cost was 857.38(698.31,1150.55)yuan,the median and interquartile range of LOS was 11(9,14)days,and most of the patients were hospitalized for 8 to 14 days,accounting for 62.47%.Hospitalization cost for patients with ischemic stroke showed a decreasing trend year by year.From 2016 to 2019,the median hospitalization cost of ischemic stroke decreased by 4222.70 yuan,with a decline rate of 34.46%,and the mean total hospitalization cost per case of ischemic stroke decreased by4703.62 yuan,with a decline rate of 31.94%.The decrease in total hospitalization cost was mainly due to the decrease in medicine fee and diagnostic fee,of which the mean medicine fee per case decreased by4507.51 yuan,with a decline rate of 55.27%,and the mean diagnosis fee per case decreased by 250.67 yuan,with a decline rate of 6.86%.(3)The composition of hospitalization cost for patients with ischemic stroke: Medicine fee,diagnosis fee and service fee were the main components of ischemic stroke hospitalization cost,accounting for 44.71%,29.92% and 15.42%,respectively.From 2016 to 2019,the proportion of medicine fee decreased year by year,with a total decrease of 18.98 percentage points,meanwhile the proportion of diagnostic fee and service fee that reflected medical value increased year by year,with a total increase of 9.16 and 8.47 percentage points,respectively.(4)Influencing factors of ischemic stroke hospitalization cost: The analysis of the factors influencing hospitalization cost showed that the basic characteristics of individuals such as gender and payment method,clinical characteristics such as admission pathways,surgery,rescue,diabetes,readmission due to stroke,death and LOS,as well as year of admission and hospital grade had statistically significant effects on hospitalization cost of ischemic patients(P<0.05).The standardized coefficient of multiple linear regression showed that the top five factors with the greatest influence were LOS,hospital grade,year of admission,surgery and rescue.Factors such as gender,hospital grade,surgery,LOS,rescue,admission pathways and readmission due to stroke had statistically significant differences in the effect on hospitalization cost in different quantile levels(P<0.05).Concluisions:(1)The hospitalization cost of ischemic stroke patients in J district of Shanghai was relatively high,but it showed a rapid decline year by year.Medicine fee,diagnosis fee and service fee,consumables fee and rehabilitation fee were the main categories of hospitalization cost for ischemic stroke patients.The proportion of medicine fee in hospitalization cost was decreasing year by year,and whlie service fee and other fee reflecting technical value were increasing year by year,the cost structure had been improved,and the labor value of medical staff was increasing year by year.(2)The increase in hospitalization days was an important controllable factor that hindered the reduction of hospitalization costs for ischemic stroke,therefore,multiple measures should be taken to reasonably shorten the patient’s LOS;the hospitalization cost increased with the increase of the hospital grade,and mild patients had lower hospitalization cost in lower-grade hospitals,but first-grade and lower-grade hospitals may lead to higher hospitalization cost due to longer LOS,therefore,we should continue to promote the hierarchical medical system,and strengthen the management of LOS in low-level hospitals;Male patients and patients with comorbidities had higher levels of medical costs and higher recurrence rates,and it is necessary to strengthen the tertiary prevention and disease management of key populations;The medical insurance system stimulated medical consumption,and it is necessary to pay attention to medical insurance supervision and reasonably implement payment methods;Patients with poor outcomes and readmission within 30 days had relatively higher hospitalization cost,therefore,we should improve the quality of medical care,improve patient outcomes,and strengthen the management of discharged patients.The conclusions drawn from a comprehensive analysis of this study provide relevant departments with a practical and targeted reference for formulating strategies to control the unreasonable increase in hospitalization cost,with good public health significance and clinical practical value.In future study,we should further explore the comprehensive influence of macro-level and micro-level factors on hospitalization cost. |
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