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目的了解住院患者分类及费用影响因素,为医院管理提供依据。方法收集某三甲医院2013年全年住院患者诊疗数据,用百分位数描述住院费用分布情况,用K-均值聚类法进行患者分类,用秩和检验分析各类患者费用差异,用ICD-10进行病种分析,用中位数回归分析住院费用的影响因素。结果该院全年住院患者175 333人次,总费用中位数10 016.31元。患者可分为7类,各类患者住院总费用之间存在统计学差异(P=0.000 1)。对无“输血费用”患者,影响患者分类的前三位费用类别为手术、化验、诊察费用;对有“输血费用”患者,影响患者分类的前三位费用类别为输血、化验、诊察费用。7类患者ICD-10亚目病种数分别为2 147、2 182、1 499、1 301、2 059、22和14种。影响住院总费用的因素可概括为患者相关和诊治相关两类。结论手术、输血、化验和诊察费用是影响住院患者分类的主要因素。研究结果可为患者收治、费用控制和病种管理提供参考。
Objective To understand the classification and costs of inpatients and provide the basis for hospital management. Methods The data of hospitalized patients in 2013 in a top three hospitals were collected. The distribution of hospitalized expenses was described by percentiles. K-means clustering was used to classify the patients. The variance of various types of patients was analyzed by rank sum test. ICD- 10 for disease type analysis, using median regression analysis of the impact of hospitalization costs. Results The hospital hospitalized 175,333 people throughout the year, the median total cost of 10 016.31 yuan. Patients can be divided into seven categories, there is a statistically significant difference between the total cost of hospitalization of various types of patients (P = 0.000 1). For the patients without “blood transfusion cost ”, the first three categories of expenses that affect the classification of patients are surgery, laboratory tests and examination fees; the first three categories of expenses that affect patients’ classification are blood transfusion, laboratory test , Check the cost. The number of ICD-10 subfamilies in 7 categories was 2 147,2 182,1 499,1 301,2 059,22 and 14, respectively. Factors affecting the total cost of hospitalization can be summarized as patient-related and diagnosis-related categories. Conclusions Surgical, blood transfusion, laboratory and diagnostic costs are the major factors influencing the classification of hospitalized patients. The results can provide reference for the treatment of patients, cost control and disease management.