Study On The Situation Of Discharged Patients With Diabetes And The Change Trend Of Hospitalization Expenses In A Province In Central China From 2015 To 2019

Objective:In the context of the continuous development of diabetes patients’ health management in basic public health services in China,we studied the hospitalization status and change trend of diabetes patients in a central province,explored the composition,change trend and influencing factors of diabetes patients’ hospitalization expenses,reflected the effectiveness and problems of diabetes patients’ health management,and provided reference for further effective implementation of diabetes health management.Methods:Through stratified and typical sampling methods,we collected the data of discharged patients from 2015 to 2019 in various hospitals at all levels in sample areas of the province,and counted the medical records and hospitalization expenses of discharged patients with the primary diagnosis of "diabetes".The descriptive statistics method was used to study the number,gender,age,length of stay,hospital level and other basic information of discharged patients with diabetes,and to study its changing trend;To study the hospitalization expenses,their composition,and their changing trends;The new grey correlation method,single factor analysis,multiple linear regression and structural equation model were used to analyze the hospitalization expenses of diabetes patients and their influencing factors.Results:The number of discharged patients with diabetes increased year by year from 12613 in2015 to 20690 in 2019,with an average annual growth of 16.0%.The proportion of discharged patients with diabetes in the total number of discharged patients rose from2.17% in 2015 to 2.79% in 2019(trend test 2=9.516,P<0.05).During the five years,the number of female discharged patients with diabetes was higher than that of male,and the ratio of male to female discharged patients was 1:1.19.The average age of discharged patients with diabetes in five years was 56.04 years old.The proportion of discharged patients with diabetes aged 40-59 years decreased from40.24% in 2015 to 34.30% in 2019,and the proportion of discharged patients with diabetes aged 60-69 years increased from 25.07% in 2015 to 28.96% in 2019(trend test 2=35.750,P<0.05).The average hospital stay of discharged patients with diabetes in five years was 10.64 days.The proportion of patients with 1-7 days of hospitalization increased from 29.39% in2015 to 37.18% in 2019;The proportion of discharged patients with diabetes whose length of stay in hospital ≥ 15 days decreased from 20.79% in 2015 to 13.86% in 2019(trend test 2=55.779,P<0.05).Institution level of discharged patients with diabetes in five years: municipal and provincial medical institutions accounted for 73.55%.Among them,the proportion of discharged patients from provincial medical institutions decreased from 46.88% in 2015 to12.03% in 2019,the proportion of discharged patients from municipal medical institutions increased from 33.28% to 61.80%,and the proportion of discharged patients from district,county,and township medical institutions increased from 20.03% to 26.17%(trend test2=32.698,P<0.05).Among discharged patients with diabetes in five years,the proportion of patients with complications decreased from 82.44% in 2015 to 81.41% in 2019,and the proportion of patients without complications increased from 17.56% to 18.59%(trend test 2=27.564,P<0.05);The proportion of diabetes patients undergoing surgery in diabetes discharged patients was 22.23% in 2017 at the highest and 14.28% in 2016 at the lowest.Among discharged patients with diabetes in five years,the proportion of insured patients showed an upward trend,from 84.19% in 2015 to 90.03% in 2019.The proportion of self funded patients in total discharged patients showed a downward trend,from 15.81%to 9.97%(trend test 2=47.490,P<0.05).From 2015 to 2019,the average hospitalization expense of discharged patients with diabetes was 7855.95 yuan,down from 8961.51 yuan in 2015 to 7042.80 yuan in 2019,a decrease of 21.41%;Among the hospitalization expenses of patients,the higher proportion of various detailed expenses is the examination fee(36.01%)and the drug fee(35.68%),while the bed fee(4.44%)and the surgery fee(2.45%)account for a lower proportion of the total hospitalization expenses.The average hospitalization expenses,drug expenses,and bed expenses showed a downward trend;Treatment and other expenses fluctuate and increase;The inspection fee showed a downward trend(P values of trend test were all<0.001).The results of the new grey correlation analysis showed that the correlation degrees between drug costs,examination costs,treatment costs,and hospitalization costs were0.9275,0.9230,and 0.7852,respectively,which had a significant impact on the total hospitalization costs;The correlation degrees of other expenses,bed expenses,and surgical expenses were 0.7407,0.7311,and 0.7217,respectively,which had a small impact on the total cost of hospitalization.Multiple linear regression showed that the number of days in hospital(β= 0.407,P<0.001),age(β = 0.108,P<0.001),surgery or not(β = 0.092,P<0.001),any complications(β= 0.023,P<0.001),whether to participate in insurance(β= 0.023,P<0.001)has a positive correlation effect on the hospitalization expenses of diabetes patients,and the level of hospitalization institutions(β=-0.381,P<0.001),Gender(β=-0.015,P<0.001)had a negative correlation effect on the hospitalization expenses of diabetes patients,and the regression model as a whole had statistical significance(F=11127.336,P<0.001).The results of structural equation model showed that the factors affecting hospitalization expenses ranged from the largest to the smallest: length of stay,level of hospitalization institution,age,whether to undergo surgery,whether to participate in insurance,gender,and whether to have complications.Conclusion:1.From 2015 to 2019,the number and proportion of discharged patients with diabetes in a central province increased year by year.The average annual growth rate of male patients with diabetes is higher than that of female patients;The average age of hospitalized patients with diabetes is 56.04 years old,and the middle-aged and elderly are the key population for diabetes management.It indicates that under the background of population aging,the province will face more severe pressure on diabetes prevention and control.2.From 2015 to 2019,the average hospitalization expenses of diabetes patients in a central province showed a downward trend.Among them,drug fees,examination fees,and bed fees have a significant downward trend.The decrease in hospitalization expenses is mainly related to the downward shift in the level of inpatient institutions,the decrease in the number of inpatient days,and the decrease in the proportion of patients with complications.On the one hand,it may be related to the development of health management for diabetes patients in China’s basic public health services for many years,which has reduced the disease severity of diabetes patients.On the other hand,it may also be related to the in-depth development of hierarchical diagnosis and treatment system.3.Examination fees and drug fees account for 71.69% of the hospitalization expenses of diabetes patients,and they are still an important part of the hospitalization expenses of diabetes patients.We should strengthen the supervision of examination fees and drug fees,reasonably reduce examination fees and drug fees,and optimize the composition of hospitalization expenses for diabetes patients.4.The results of multiple linear regression analysis and structural equation model showed that the most influential factor on hospitalization expenses was the length of stay.The longer the stay,the more resources consumed,and the higher the hospitalization expenses.We should shorten the number of invalid and inefficient hospitalization days,implement a clinical pathway management model,optimize the diagnosis and treatment process,scientifically and reasonably arrange the patient’s hospitalization time,and accelerate the speed of hospital bed turnover.5.From 2015 to 2019,diabetes patients in a certain province in central China mainly went to high-level medical institutions,indicating that grass-roots medical institutions did not play a good role in providing basic services.The service utilization level of basic level medical institutions needs to be further improved.We should constantly strengthen the construction of basic level health care,carry out health education and screening for high-risk groups based on the basic level,and strengthen the prevention of diabetes.