终末期安宁疗护病人住院费用的影响因素分析及对策研究

doi:10.3969/j.issn.1003-9198.2021.09.015

摘要/Abstract

摘要： 目的分析南京市医联体内不同医疗机构中安宁疗护住院死亡病人临终前30 d的住院费用,为构建区域内安宁疗护医保费用导向体系提供参考。方法采用回顾性研究方法,以南京市2017年11月至2020年3月三甲医院(78例)和基层医院(80例)的安宁疗护住院死亡病人为研究对象。比较2家医疗机构病人的年龄、性别、住院天数、医疗付费方式、肿瘤部位及临终前30 d住院费用(治疗费、检查费、药品费、护理费、其他费用),并运用Spearman相关系数及多元回归分析终末期安宁疗护病人住院费用的影响因素。结果不同医疗机构病人的年龄、性别、住院天数、医疗付费方式、肿瘤部位差异均无统计学意义(P>0.05),三甲医院病人的住院总费用、治疗费、检查费、药品费、护理费、其他费用均高于社区医院(P＜0.05)。Pearson相关分析显示,医院级别与住院总费用相关程度最高(r=-0.485,P＜0.001),其次为住院天数(r=0.442,P＜0.001)和医疗付费方式(r=-0.198,P＜0.05)。多元回归分析结果表明,医院级别和住院天数是终末期安宁疗护病人住院费用的独立影响因素。结论与三级医疗机构安宁疗护单元相比,基层医疗机构能够为安宁疗护病人提供优质住院服务的同时明显降低其住院医疗费用。建议未来应改革安宁疗护支付方式,将安宁疗护纳入医保支付体系;扩大安宁疗护开展范围,推进基层安宁疗护发展;提高基层医疗机构终末期肿瘤病人安宁疗护介入率。

关键词: 肿瘤晚期, 安宁疗护, 住院病人, 费用分析

Abstract: Objective To analyze the 30 d hospitalization expenses before death in the patients with end-of-hospice care in different medical institutions of the Nanjing Medical Union, so as to provide a reference for the construction of the regional system of end-of-hospice care. Methods The clinical data of 158 hospice patients in two medical institutions from November 2017 to March 2020 were retrospectively analyzed, including 78 cases in a grad A class 3 hospital and 80 cases in a community hospital. The age, gender, length of hospitalization, medical payment method, tumor location, 30 d hospitalization expense before the death (treatment expense, inspection expense, medicine expense, nursing expense, other expenses) were compared between the two medical institutions. The influencing factors of the hospitalization expense for the end-stage palliative care were analyzed by Pearson correlation analysis and multiple regression analysis. Results There were no significant differences in age, gender, length of stay, medical payment method and tumor location between the two medical institutions (P>0.05). The total hospitalization expense, treatment expense, inspection expense, medicine expense, nursing expense and other expenses of the patients in the grade A class 3 hospital were higher than those in the community hospital (P＜0.05).Spearman correlation analysis showed that the hospital grade and the total hospitalization expense had the highest correlation (r=-0.485, P＜0.001), followed by the number of hospitalization days (r=0.442, P＜0.001) and the medical payment method (r=-0.198, P＜0.05). Multivariate regression analysis showed that hospital grade and length of stay were independent influencing factors of the hospitalization expense for end-stage palliative care patients. Conclusions Compared with the hospice care unit in a grade A class 3 hospital, primary medical institutions can provide quality inpatient services for hospice care patients, while significantly reducing their inpatient medical expenses. In the future, we should reform the payment method for hospice care, expanding the scope of hospice care and promoting the development of primary medical institutions, thereby improving the hospice care intervention rate for the patients with end-stage cancer in primary medical institutions.

Key words: advanced tumor, hospice care, hospitalized patient, cost analysis

中图分类号:

R 48

张秋会, 李娜, 殷小莉, 袁玲. 终末期安宁疗护病人住院费用的影响因素分析及对策研究[J]. 实用老年医学, 2021, 35(9): 953-956.

ZHANG Qiu-hui, LI Na, YUAN Ling, YIN Xiao-li. Study on influencing factors and countermeasures of hospitalization expenses of patients with end-of-hospice care[J]. Practical Geriatrics, 2021, 35(9): 953-956.

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