Research On Hospitalization Expenses And Case Mix Of Rheumatic Disease Patients In A Tertiary Hospital In Dalian

Objective:To understand the internal composition,change trend and influencing factors of hospitalization expenses of patients with rheumatic diseases.In order to find out the factors that cause the unreasonable increase of hospitalization expenses and put forward effective countermeasures.Explore the case combination of patients with rheumatic diseases,provide scientific basis for strengthening the control and management of hospitalization expenses of patients with rheumatic diseases,and provide technical methods and support for formulating the localization grouping scheme of rheumatic diseases and disease payment standards.Methods:This study included 6299 patients with rheumatic diseases hospitalized in a tertiary hospital in Dalian from 2015 to 2019.The basic information of patients,clinical characteristics and hospitalization expenses were extracted through the information system on the first page of the medical record.The relative importance of the internal factors affecting the hospitalization expenses was compared by using the grey correlation analysis method.To understand the change trend of the composition of hospitalization expenses by using the structural change analysis method.The decision tree model test(CHAID)was used for case combination study.Then determine the upper limit of the reference value of each group,calculate the excess cases,and verify the effect of the model.SPSS 23.0 software was used for statistical analysis.Different data were described by frequency,constituent ratio,average value and median(quartile).Non-parametric test(chi-square test or rank sum test)was used to analyze the influencing factors of hospitalization expenses.Multivariate linear regression model(stepwise regression method)was used for multifactor analysis.Set the test level as 0.05(both sides),P<0.05 indicates that the difference is statistically significant.Results:1.From 2015 to 2016,the growth rate of hospitalization expenses for patients with rheumatic diseases reached 11.00%,1.29% in 2017,-22.50% in 2018 and 8.92% in 2019.In the composition of total hospitalization expenses,diagnosis expenses ranked the first,accounting for 52.90%,showing an upward trend year by year;The drug cost ranked second,accounting for 26.85%,showing a trend of rising first and then falling.The grey correlation analysis shows that according to the degree of correlation,the impact of various expenses on the total cost of hospitalization is from large to small: diagnosis fee,drug fee,general treatment operation fee,general medical service fee,other expenses,medical consumables fee,nursing fee,surgical treatment fee,rehabilitation fee and blood transfusion fee.The result of structural change analysis shows that the main items that affect the change of the total hospitalization expenses of rheumatic patients are still the diagnosis expenses and drug expenses.2.Through univariate and multivariate analysis,it was found that the total hospitalization expenses of patients with rheumatic diseases were related to the way of medical payment,the way of admission,the length of stay and the combination of other diagnoses,and the difference was statistically significant(P<0.05).The patients who use the basic medical insurance pay higher hospitalization expenses than those who pay at their own expense;The hospitalization cost of emergency patients is higher than that of outpatient patients;With the increase of hospitalization days,the hospitalization expenses of patients with rheumatic diseases increased;Patients with other diseases have higher hospitalization costs than those without other diseases.3.The number of days in hospital,whether to merge other diagnosis and admission routes are used as the first,second and third node variables to finally enter the decision tree model,forming six case combinations.Group 5(8-14 days in hospital;combined with other diagnosis;outpatient admission)has the largest number of cases,accounting for 62.3%,and the average hospitalization cost is 15243.08 yuan;Group 6(8-14 days in hospital;combined with other diagnosis;emergency admission)has the lowest number of cases,accounting for1.7%,with an average value of 17328.77 yuan;The average hospitalization cost of group 1(hospitalization ≥ 15 days)was the highest,with an average of 28325.58 yuan;The average hospitalization cost of group 4(1-7 days in hospital;no other diagnosis)was the lowest,4101.75 yuan.Compared with the upper limit of the reference value of hospitalization expenses in each group,there were 150 cases in total,accounting for 2.38%.Kruskal-Wallis H test results showed that the heterogeneity between groups was large.The coefficient of variation test only showed that the CV of the fourth group was greater than 1,and the coefficient of variation of other combinations was less than 1.The homogeneity within the group was good.Conclusion:1.During the period from 2015 to 2019,the hospitalization expenses of patients with rheumatic diseases showed a trend of large increase-large decrease-small increase.Diagnosis cost and drug cost are the main items of hospitalization cost.The reform of the medical system has played a certain role in curbing the trend of unreasonable and rapid growth of medical expenses.Hospitals should adjust the structure under the premise of controlling the total hospitalization expenses,use drugs reasonably,avoid excessive examination,and standardize medical behaviors.2.The hospitalization expenses of patients with rheumatic diseases who use basic medical insurance to pay for admission through emergency treatment,have long hospitalization days and have other combined diagnoses are high.It is suggested that we should make full use of health resources,improve the overall operation efficiency and effectively shorten the average length of stay;Popularize disease prevention knowledge,improve residents’ health awareness,reduce the severity of the disease,and jointly reduce hospital costs in many ways.3.The case combinations of the six groups have great heterogeneity among groups,high homogeneity within groups,and reasonable grouping effect.In all 6299 patients,the excess cases accounted for 2.38%.The hospital should strictly check the information of the excess cases and pay more attention to it,while controlling the number of excess cases and unreasonable consumption of medical resources.