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