| ObjectiveIn order to study the changes in the structure of hospitalization expenses for all cesarean section cases and severe complications and complications of cesarean section cases in a tertiary hospitaland and find out the effect of influencing factors on the cost of cesarean section hospitalization.,We has analyzed the influencing factors of hospitalization expenses for all cesarean section cases and severe complications and complications of cesarean section cases.We conducted a DRGs group study on all cesarean section cases and severe complications and complications of cesarean section cases,and obtained a subdivision group plan of severe complications and comorbidities in the DRGs grouping of cesarean section cases.This provides reference suggestions for the medical insurance department to improve the DRGs grouping plan.MethodsThis study extracteds the medical record first page data information of the cesarean section cases from 2016 to 2020 from the medical record home page system of the sample hospitals,mainly including: the patient’s hospitalization number,age,admission route,patient source,ethnicity,discharge time,hospitalization days,admission department,discharge department,name and ICD code of main diagnosis,name and ICD code of other diagnosis,name and ICD code of main operation,name and ICD code of other operation,rescue status,transfer status,blood transfusion status,cost information,etc.First,this study conducted a descriptive analysis of the demographic characteristics and the structure of hospitalization costs;secondly,we used analysis of variance,t-test and rank correlation to determine the hospitalization costs of all cesarean section cases and severe complications and complications.The influencing factors are analyzed by single factor and the correlation test between the factors;then,multiple linear regression and path analysis are used to conduct a multi-factor analysis of the hospitalization expenses of cesarean section cases;finally we use the chi-square automatic interactive test in the decision tree The method(CHAID)is used to group the cases,and the non-parametric Kruskal-Wallis test and the coefficient of variation(CV)are used to judge the rationality of the results of the case grouping.These results were statistically significant with P<0.05,All statistical analyses are performed using the SPSS24.0 and Amos Graphics,and take P<0.05 as the difference is statistically significant.Results(1)From 2016 to 2020,the age group of cesarean section cases in sample hospitals is mainly 25-40 years old,and 56.69% of cesarean section cases have serious complications and comorbidities.The average hospital stays of the total cesarean section cases gradually decreased from 5.18 days to 4.63 days,and the average hospital stay of severe complications and complications of cesarean section cases gradually decreased from 5.64 days to 4.95 days.The overall average daily hospitalization cost of cesarean section cases has gradually increased from 258.61 yuan in 2016 to 3105.88 yuan in 2018,and then gradually decreased to 2854.57 yuan in 2020.The average daily hospitalization cost of severe complications and complications of cesarean section cases gradually increased from 2454.54 yuan in 2016 to 3048.27 yuan in 2018,and then gradually decreased to 2842.23 yuan in 2020.(2)The structure of hospitalization expenses for all cesarean section cases and the structure of hospitalization expenses for severe complications and complications of cesarean section cases have changed.The trends in comprehensive medical service fees: The proportion of comprehensive medical service fees for all cesarean section cases has gradually increased from 7.74% in 2016 to 12.38% in 2020.The average cost per time has gradually increased from 912.86 yuan in 2016 to 1712.29 yuan in 2018 and then gradually decreased to 1541.55 yuan in 2020.The proportion of comprehensive medical service fees for severe complications and complications of cesarean section cases has gradually increased from 7.86% in 2016 to 12.52% in2020.The average cost per time has gradually increased from 991.52 yuan in2016 to 1840.52 yuan in 2018 and then gradually decreased to 1638.87 yuan in2020.The trends in diagnostic fees: The percentage of diagnostic fees for all cesarean section cases has gradually decreased from 27.24% in 2016 to 23.79%in 2019 and then increased to 25.47% in 2020.The average cost per time for all cesarean section cases has gradually increased from 3214.38 yuan in 2016 to3335.66 yuan in 2018 and then gradually decreased to 3,171.64 yuan in2020.The proportion of the diagnosis fee for severe complications and complications of cesarean section cases gradually increased from 27.81% in2016 to 23.97% in 2019 and then dropped to 25.57% in 2020.The average cost per time for severe complications and complications of cesarean section cases increased from 3507.61 yuan in 2016 to 3585.52 yuan in 2017 and then gradually decreased to 3346.43 yuan in 2020.The trends in treatment costs.The proportion of treatment costs for all cesarean section cases gradually increased from 36.85% in 2016 to 38.87% in2018 and then gradually decreased to 32.91% in 2020.The average cost per cesarean section has gradually increased from 4347.62 yuan in 2016 to 5438.46 yuan in 2018 and then gradually decreased to 4097.51 yuan in 2020.The proportion of the treatment cost of severe complications and complications of cesarean section cases gradually increased from 35.43% in 2016 to 37.53% in2018 and then gradually decreased to 32.25% in 2020.The average cost of severe complications and comorbidities for cesarean section cases has gradually increased from 4469.00 yuan in 2016 to 5584.38 yuan in 2018 and then gradually decreased to 4220.13 yuan in 2020.The trends in drug costs.From 2016 to 2020,the proportion of drug costs for cesarean section cases rose from 9.40% to 15.31%,and the average cost per time for all cesarean section cases rose from 1108.88 yuan to 1906.90 yuan.From 2016 to 2020,the proportion of drug costs for severe complications and complications of cesarean section cases gradually increased from 9.79% to15.66%,and the average cost per time rose from 1234.95 yuan to 2049.90 yuan.The trend of changes in consumables costs.From 2016 to 2020,the total cost of consumables for cesarean section cases decreased from 16.52% to 9.32%,and the average cost per time decreased from 1949.49 yuan to 1160.66 yuan.From 2016 to 2020,the proportion of consumables for severe complications and complications of cesarean section cases decreased from 16.48% to 9.35%,and the average cost per time decreased from 2078.27 yuan to 1223.56 yuan.(3)The main influencing factors of hospitalization expenses for all cesarean section cases are serious complications and complications,transfer to the department,blood transfusion,rescue,other operations,and elderly parturients.The main influencing factors of the hospitalization cost of severe complications and complications of cesarean section cases are transfer,other operations,blood transfusion,rescue,and admission.Among the influencing factors of the hospitalization costs of the two types of cesarean section cases,the same influencing factors are transfer,other operations,blood transfusion,and rescue.The different influencing factors are severe complications and comorbidities.Older parturients have an impact on the hospitalization costs of all cesarean section cases,and the admission route has an impact on the hospitalization costs of severe complications and comorbidities.(4)In the path analysis results of the influencing factors of the hospitalization cost of all cesarean section cases,serious complications and complications,transfer,blood transfusion,rescue,and other operations not only directly affect the total hospitalization cost of all cesarean section cases in Ln The length of hospital stay indirectly affects the total hospitalization cost of all cesarean section cases in Ln,and the elderly women directly affect the total hospitalization cost of all cesarean section cases in Ln.The total effects of all influencing factors of hospitalization expenses for all cesarean section cases were 0.258 for blood transfusion,0.211 for rescue,0.145 for transfer,0.130 for serious complications and comorbidities,0.087 for other operations,and 0.017 for elderly women.In the path analysis results of the influencing factors of the hospitalization cost of severe complications and complications of cesarean section cases,transfer,blood transfusion,rescue,and other operations not only directly affect the total hospitalization cost of Ln severe complications and complications of cesarean section cases,but also the length of hospital stay indirectly affects the total hospitalization cost of Ln severe complications and complications of cesarean section.The total effect of the factors affecting the hospitalization cost of severe complications and complications of cesarean section cases is 0.511 days,0.288 for blood transfusion,0.237 for rescue,0.172 for transfer,and 0.067 for other operations.(5)The DRGs of all cesarean section cases are divided into 6 groups,namely group A without serious complications and comorbidities and no other surgery group,group B without serious complications and comorbidities,no other surgery and no transfer group,and C Group has no serious complications and comorbidities,there are other operations with transfer group,group D has serious complications and comorbidities,there is a rescue group,group E has serious complications and comorbidities,there is no rescue without other surgery group,group F has serious complications Symptoms and comorbidities have other surgical groups without rescue.The DRGs of severe complications and complications of cesarean section cases are divided into 5 groups,namely group a with rescue group,group b without rescue without other surgery and without transfer group,group c without rescue and no other surgery with transfer group,Group d has no rescue with other operations and no transfer group,group e has no rescue with other operations and transfer group.Conclusion(1)From 2016 to 2020,the proportion of consumables in the hospitalization cost structure of cesarean section cases in a hospital in Guangxi has decreased year by year.However,the proportion of comprehensive medical service costs and the proportion of drug costs have increased year by year.In addition,treatment costs accounted for the first After rising and then falling,the proportion of diagnostic fees first gradually decreased and then showed signs of recovery.(2)The influencing factors of the average daily hospitalization cost of all cesarean section cases are serious complications and complications,transfer,blood transfusion,rescue,other operations,and elderly women.The influencing factors of the average daily hospitalization costs of severe complications and complications of cesarean section cases are transfer,blood transfusion,rescue,other operations,and hospital admissions.(3)Older parturients directly affect the total hospitalization costs of all cesarean section cases.Severe complications and complications,transfer,blood transfusion,rescue and other operations not only directly affect the total hospitalization expenses of all cesarean section cases,but also indirectly affect the total hospitalization expenses of all cesarean section cases through the length of hospital stay.Department transfer,blood transfusion,rescue and other operations directly affect the total hospitalization cost of severe complications and comorbid cesarean section cases,and indirectly affect the total hospitalization cost of severe complications and comorbid cesarean section cases through the length of hospital stay.There was no statistical difference in the total hospitalization cost of severe complications and comorbid cesarean section cases in the way of admission,but it had an impact on the average daily hospitalization cost of severe complications and comorbid cesarean section cases.(4)The DRGs of all cesarean section cases were divided into 6 groups,and the DRGs of severe complications and comorbidities were divided into 5 groups. |
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