| Objectives:To find out the utilization of health services,the cost of hospitalization and the influencing factors of functional recovery of DDH patients,and to measure their economic burden of disease comprehensively,so as to provide feasible suggestions for reducing the economic burden of DDH patients.Method:By using the method of questionnaire survey,we can understand the history of DDH patients,the status of previous diagnosis and treatment,disability level and family financial burden before treatment,and master the functional recovery of patients in different periods after treatment,the number of days off work during rehabilitation and the level of family financial burden.The path analysis model was established to explore the factors influencing the inpatient cost of DDH patients;the Cox proportional risk model was established through survival analysis to screen the factors affecting the functional recovery of DDH patients;the direct economic burden of patients was measured by direct method,and the indirect economic burden was measured by the combination of human capital method and YLD.Result:(1)In this study,853 patients were investigated at baseline,87 patients were lost during the follow-up period,and 766 patients were finally investigated,with a loss rate of 11.36%.(2)The main diagnosis institutions of patients were tertiary hospitals(42.95%)and secondary hospitals(37.34%)The percentage of patients with Crowe type Ⅱ was the highest(36.95%).(3)In 2015-2019,DDH patients had three visits per year,and there was a significant difference in outpatient visits in the past three months among patients with different education level,employment situation,patient source and visit time(P < 0.05).The annual average hospitalization rate of DDH patients in2015-2019 was 17.10%;there was a significant difference in hospitalization in the past 12 months among patients of different ages,employment,medical insurance,treatment delay and treatment time(P<0.05).(4)The sum of drug cost,operation cost and material cost accounts for more than 75% of the total inpatient cost.The education level,the average family income and the treatment mode are not only the factors that affect thehospitalization expenses of DDH patients,but also the factors that affect the hospitalization days of DDH patients.The total effect of the treatment mode and the hospitalization days on DDH patients is 0.906 and 0.265,respectively.(5)DDH patients of different age groups,treatment methods,and Crowe classification before treatment had statistically significant differences in the scores of the four dimensions of pain,mobility and deformity,walking ability,and daily living ability(P<0.05);12 months and over after treatment,patients in different age groups had statistically significant differences in scores and total scores in three dimensions except for activity and deformity(P<0.05),different Crowe classification and treatment methods The difference in pain dimension scores and total scores was statistically significant among the patients(P < 0.05).(6)There was a statistically significant difference in hip function recovery among DDH patients with different ages,education levels,medical insurance,patient source,treatment method,Crowe classification before treatment,years of treatment delay,and average monthly family income(P <0.05);At the same follow-up time,the function of patients over 60 years of age may return to normal by 0.116 times(P < 0.05).Patients with an average monthly income of 5,000 yuan or more may return to normal function than those at home.The average monthly income was less than 1,000 yuan(P<0.05).(7)The total economic burden of DDH patients was 388630.03 yuan,the direct economic burden was 43001.62 yuan and the indirect economic burden was 345628.41 yuan.Among the four types of Crowe before treatment,the lowest total disease economic burden of type I patients was74326.12 yuan;the total disease economic burden of closed reduction patients was19829.32 yuan lower than that of osteotomy and artificial hip replacement patients Conclusion:(1)DDH patients have longer treatment delays,family economic difficulties and limited hospital service capacity are important reasons for treatment delays.Delays in treatment lead to high pre-treatment disability rates in DDH adults.DDH patients have a high utilization rate of health services.Age,education,and average monthly household income will affect their utilization of health services.(2)Drug expenses,surgery expenses and materials expenses are the main components of the total hospitalization expenses of DDH patients.The main factors affecting the hospitalization expenses of DDH patients are the treatment method,length of stay,age,average family income and education level.(3)Lower extremity function of DDH patients can be significantly improved after treatment,and Harris score is significantly improved after 3 months of treatment.With the same recovery time after treatment,functional recovery was better in patients aged 2 to 4 years and with an average monthly household income of more than 5,000 yuan.(4)Theeconomic burden of DDH patients is heavy,and it mainly comes from the indirect economic loss caused by the loss of life years.The higher the Crowe classification and the more complex the treatment,the heavier the economic burden of the disease.Early diagnosis and early treatment is an effective way to reduce the economic burden of DDH patients. |
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