原发性肝癌手术患者住院费用影响因素关联度分析
安琳 张成 冯金鸽 安东均
摘 要
目的：分析陕西省某三甲医院2015～2018年肝癌手术患者住院费用及其构成，为合理控制住院费用的支出，推行DRG支付方式提供参考依据。
方法：收集312例肝癌手术患者的出院病历资料，住院费用采用Kruskal-Wallis H检验，进行单因素分析。将单因素分析中有差异的因素作为自变量，住院天数的对数值作为因变量，构建结构方程并采用Maximum likelihood法进行参数估计，得到各变量之间的路径系数。对各变量的路径系数进行效应分解。总效应值的大小反映了各因素对住院费用的关联程度。
结果：对住院费用影响最大的是住院天数，路径系数为0.55，其他影响因素依次为手术方式、术后近期并发症、年龄、医保类型。
结论：提高医院的管理水平、诊疗水平和工作效率。加快病床周转，减少平均住院日、降低诊疗成本（包括高值耗材的合理应用），可合理控制肝癌手术患者的诊疗费用，减轻患者经济负担并为推行DRG支付方式提供参考依据和借鉴。
关键词
肝癌；住院费用；影响因素；外科手术；关联度
Correlation Analysis of Influencing Factors on Hospitalization Expenses of Patients with Primary Liver Cancer Surgery
AN Lin，ZHANG Cheng，Feng Jinge，AN Dongjun
ABSTRACT
Objective:To analyze the hospitalization expenses and their composition of liver cancer patients in a tertiary hospital in Shaanxi province from 2015 to 2018，and to provide reference basis for reasonable control of hospitalization expenses and implementation of DRG payment method.
Methods:The discharge medical records of 312 patients with liver cancer surgery were collected，and the hospitalization expenses were examined by Kruskal-Wallis H test，and single factor analysis was conducted.Taking the different factors in single factor analysis as independent variables and the logarithmic value of hospitalization days as dependent variables，the structural equation is constructed and the Maximum likelihood method is used to estimate the parameters，thus obtaining the path coefficients between the variables.The path coefficient of each variable is decomposed into effects.The magnitude of total effect value reflects the degree of correlation between various factors and hospitalization expenses.
Results:The most influential factor on hospitalization expenses is the length of stay，with a path coefficient of 0.55.The other influencing factors are operation mode，short-term postoperative complications，age and medical insurance type.
Conclusions:To improve the management level，diagnosis and treatment level and work efficiency of the hospital.Accelerating the turnover of hospital beds，reducing the average length of stay，and reducing the cost of diagnosis and treatment（including the reasonable application of high-value consumables）can reasonably control the cost of diagnosis and treatment for patients undergoing liver cancer surgery，reduce the economic burden of patients，and provide reference for the implementation of DRG payment methods.
KEY WORDS
Liver cancer；Hospitalization expenses；Influencing factors；Surgery；Degree of correlation Corresponding author:AN Lin.School of statistics，xi'an university of finance and economics710100；Email:1158011981@qq.com
在我国肝炎病毒感染是肝癌发生的最主要原因。临床调查资料显示，病毒性肝炎约有10%会发展成慢性活动性肝炎，而慢性活动性肝炎中有50%可发展成肝硬化，肝硬化发生肝癌的概率约9.9～16.6%。其中以乙型肝炎为主。《2017中国肿瘤的现状和趋势报告》显示，原发性肝癌是我国第3位的常见恶性肿瘤及第2位的肿瘤致死病因，全国肝癌每年新发病例约40万，死亡约38万。用“肝癌大国”来形容中国并不为过。肝癌在严重威胁生命的同时，也给国家、社会和家庭带来沉重的疾病经济负担。本研究对肝癌手术患者住院费用的构成采用结构方程模型分析其各因素之间的相关性，为合理控制肝癌手术患者的诊疗费用，优化卫生资源配置、完善相关医疗保障政策、减轻患者经济负担和推行DRG（疾病相关分组）支付方式提供参考依据和借鉴。