Study On Hospitalization Expenses And Case Combination Of Patients With Acute Myocardial Infarction In A Tertiary Hospital In Xinjiang

Objective: Based on the data of hospitalized patients with acute myocardial infarction in a 3A hospital in Xinjiang from 2015 to 2019,and based on the influencing factors of medical expenses of patients with acute myocardial infarction,this study uses the decision tree model to study the case combination,so as to explore the classification criteria that accord with the population characteristics and disease characteristics of the region,and provide reference for formulating the localized grouping scheme of acute myocardial infarction cases and promoting DRGs prepayment system in the region.Methods: To collect the first page data of hospitalized patients with acute myocardial infarction from 2015 to 2019 in a 3A hospital in Xinjiang.Understand the sociological and clinical characteristics of patients through descriptive analysis;Grey correlation method and structural change degree analysis method are used to analyze the composition and change of hospitalization expenses of patients The factors affecting the total hospitalization expenses of patients with acute myocardial infarction were analyzed by single factor,multiple linear regression and path analysis The decision tree model was used to construct the case combination scheme of patients with acute myocardial infarction,and the standard hospitalization expenses of each combination were worked out.Results:(1)A total of 4366 patients with acute myocardial infarction and 3535 male patients were included in this study,accounting for 80.97% of the total number.There were 831 female patients,accounting for 19.03% of the total number.(2)Distribution of clinical characteristics of patients with acute myocardial infarction: The patients with 5-10 days are the most,with 2933 cases,accounting for 67.18%;At the time of admission,there were 1057 ordinary patients,accounting for 24.21%,second only to emergency patients;There are 3604 patients treated by surgery,and the number of patients is 4.73 times that of non-surgical treatment;There were 2712 patients admitted to hospital in emergency department,accounting for 62.12% of the study cases.Patients with complications or complications accounted for 91.82% of the total patients.(3)The factors affecting the average hospitalization expenses of patients with acute myocardial infarction have the largest correlation coefficient,which is 1.0000 in each year,followed by drug expenses and diagnosis expenses;The top three factors affecting the average total cost are medical consumables,drugs and diagnosis.The results of structural change analysis show that the total structural change of hospitalization expenses from 2015 to 2019 is 11.97%,and the structural change of hospitalization expenses from 2017 to 2018 is the largest,which is12.16%.From 2015 to 2019,the expense items that caused great changes in the structure of hospitalization expenses were drug expenses,treatment expenses and operation expenses,with a cumulative contribution rate of 84.63%.In each fixed number of years,drug expenses and consumables expenses were important expense items that affected the change degree of the overall expense structure in four years.(4)The comprehensive influencing factors of total hospitalization expenses of patients with acute myocardial infarction include gender,age,length of stay,treatment methods,admission route,presence of complications or complications,admission conditions,and full self-expense.(5)The case combination scheme of 12 groups of patients with acute myocardial infarction was established by decision tree,and the model fitted well after examination.Conclusion: We should pay close attention to the incidence of acute myocardial infarction in young people while deeply studying the prevalence of middle-aged and elderly people.Among the expenses of inpatients,the expenses of medicines and consumables account for a relatively high proportion,while the expenses of medical services and nursing care account for a relatively small proportion,so the structure of hospitalization expenses should be appropriately optimized and regulated.Hospitalization days and treatment methods are the main influencing factors of hospitalization expenses.Therefore,improving the utilization rate of hospital beds and reducing invalid hospitalization time of patients can effectively alleviate the burden of hospitalization diseases.The results of acute myocardial infarction case combination study show that the grouping is reasonable,but it needs to be further optimized in combination with the actual situation,and pay attention to the patients outside the line and the consumption of resources outside the line.