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目的探讨影响胃癌患者住院费用的主要因素。方法收集某肿瘤专科医院2009-2014年5年间7 386例胃癌患者的病案信息,采用逐步回归分析法以住院费用、住院天数为内生变量,拟合通径分析模型,筛选影响住院费用的直接效应和通过住院天数影响住院费用的间接效应。结果手术与否是影响住院费用的最主要因素;住院天数、转归情况、住院年份、伴随病、性别、年龄和职业直接影响住院费用;出院主诊断和医付方式间接影响住院费用;转归情况、手术与否、伴随病、住院年份等因素既可直接影响住院费用,又通过住院天数间接影响住院费用。手术与否、住院天数、转归情况影响住院费用总效应分别为0.604、0.585、-0.387。结论要降低住院费用,需要多部门共同努力,加强监督管理,合理治疗,合理用药,规范临床路径,优化治疗检查流程,完善多层次社会健康保障体系。
Objective To explore the main factors affecting hospitalization costs of patients with gastric cancer. Methods A total of 7 386 cases of gastric cancer were collected from a cancer specialist hospital in 2009-2014 during the five years from 2009 to 2014. The hospitalization costs and hospitalization days were taken as the endogenous variables and the path analysis model was fitted by stepwise regression analysis. The effect and the indirect effects of hospitalization through hospitalization days. Results Hospitalization or not is the most important factor affecting the hospitalization cost; the number of days of hospitalization, the outcome of the hospitalization, the length of hospitalization, the accompanying disease, sex, age and occupation directly affect the hospitalization expenses; the diagnosis and payment of hospitalization indirectly affect the hospitalization expenses; Conditions, surgery or not, accompanying diseases, hospitalization years and other factors can directly affect the cost of hospitalization, but also indirectly affect the cost of hospitalization through the number of hospital days. The total effect of hospitalization costs on surgery or not, number of days of hospitalization and outcome of the hospitalization were 0.604, 0.585 and -0.387, respectively. Conclusion To reduce hospitalization costs, we need to work together in many departments to strengthen supervision and management, rational treatment, rational use of drugs, standardize clinical pathways, optimize the treatment inspection process, and improve the multi-level social health security system.