| Objects:This study conducted a descriptive analysis of the basic situation of elderly inpatients aged 60 and over in a comprehensive tertiary hospital in a city from2016 to 2020 to understand the changes in the composition of disease spectrum and hospitalization expenses of elderly inpatients.Based on the number of elderly inpatients,according to the disease spectrum of elderly inpatients,the trend of hospitalization expenses of elderly patients with primary diseases over time was analyzed,and the composition of hospitalization expenses and its influencing factors were discussed,so as to provide reference for coping with the increase of hospitalization expenses of elderly patients,optimizing the structure of hospitalization expenses and preventing diseases of the elderly.Methods:The elderly inpatients from 2016 to 2020 in the information management system of a comprehensive tertiary hospital in a city were selected,and a total of228351 elderly patients were included in the study according to the inclusion and exclusion criteria;Descriptive analysis was used to analyze the distribution characteristics and hospitalization expenses of elderly inpatients;Grey relational analysis and structural variation analysis were used to analyze the composition of hospitalization expenses of elderly patients with diseases categories who ranked first in the number of patients with disease spectrum;Through single factor and multiple linear regression analysis,the influencing factors of hospitalization expenses of elderly patients with this diseases categories were analyzed.On this basis,path analysis was carried out to further analyze the influencing factors of hospitalization expenses.Results:1.During the five years,the number of elderly inpatients increased significantly in the remaining years except for the decrease in the number of inpatients in 2020,among which the majority of patients were male(52.78%);the average age was 70.86 ± 8.37 years old,and the most patients were 60-64 years old(28.55%);the average hospitalization days was 9.30 days,and the proportion of hospitalization days <10 days was the highest(64.98%);the patients were mainly admitted to the outpatient department(76.30%).The patient ’s admission condition has been clearly accounted for the largest proportion at the time of admission(85.70%);most patients were not transferred department(95.41%);there were more patients without surgical treatment(65.09%).2.From 2016 to 2020,the top five disease categories of the cumulative number of hospitalized elderly patients were : circulatory system diseases 67644 cases(29.62%),factors affecting health status and contact with health care institutions 38371 cases(16.80%),digestive system diseases 24931 cases(10.92%),cancers 14713 cases(6.44%)and nervous system diseases 13506 cases(5.91%).During the five years,the average hospitalization cost of elderly inpatients decreased first and then increased,and reached a maximum of 22912.47 yuan in 2020,from the perspective of the average hospitalization cost of all disease categories,the top five diseases were : injury,poisoning and some other consequences of external causes(42725.19 yuan),tumor(34810.36 yuan),musculoskeletal system and connective tissue diseases(28369.11yuan),circulatory system diseases(27060.28 yuan),congenital malformations,deformation and chromosomal abnormalities(20578.05 yuan);among all diseases categories,the average length of stay was 9.30 days.Among them,the average length of stay of tumor system diseases was the most(13.52 days),and the average length of stay of mental and behavioral disorders was the least(7.56 days).Among them,the average length of stay of injury and poisoning and some other consequences of external causes,blood and hematopoietic organ diseases and some diseases involving immune mechanisms,skin and subcutaneous tissue diseases exceeded 10 days.Among all systemic categories,the proportion of patients with tumors receiving surgery was the highest,accounting for 79.53%,and the proportion of patients with neurological diseases receiving surgery was the lowest,accounting for 9.44%.Among them,diseases categories with a surgical proportion of more than 50% also include eye and appendage diseases(77.16%),injuries,poisoning and certain other consequences of external causes(74.07%).3.Among the circulatory system diseases,which ranked first in the disease spectrum,the composition of hospitalization expenses of elderly patients: material costs,drug costs,and diagnostic costs are the main factors affecting the composition of hospitalization expenses of elderly patients.The correlation between the costs and hospitalization expenses is in order from strong to weak: material costs,drug costs,diagnostic costs,general medical service costs,treatment costs,surgical costs,nursing costs,blood transfusion costs,rehabilitation costs,and other costs.From 2016 to 2020,the contribution rate of structural changes in drug costs(49.11%),material costs(23.19%)and diagnostic costs(17.08%)was higher,and the cumulative structural contribution rate was 89.38%.4.Disease spectrum ranked first in the elderly circulatory system disease age,gender,medical payment,way out of hospital in the doctor ’s advice out of hospital,admission conditions,length of stay,admission way,whether the transfer department,whether surgery were the factors affecting the hospitalization expenses of elderly patients(P < 0.05).5.The results of path analysis showed that age,gender,medical payment,doctor ’s advice to leave hospital,admission condition,admission route,whether to transfer department,and whether to operate not only had a direct effect on the hospitalization expenses of elderly patients with circulatory system diseases ranked first in the disease spectrum,but also had an indirect effect on hospitalization expenses through hospitalization days;discharged without doctor’s advice,unemployed people,and retired people only have an indirect effect on hospitalization expenses through hospitalization days.The total effect of whether or not to have surgery,hospitalization days,and admission pathway factors on the hospitalization expenses of elderly patients with circulatory system diseases ranked first in the disease spectrum ranks the top three.Conclusion:The disease burden of elderly inpatients in the past five years was mainly circulatory system diseases,factors affecting health status and contact with health care institutions,and digestive system diseases.There are interannual fluctuations in the average hospitalization expenses and individual expenses of elderly inpatients,and the overall hospitalization expenses are on the rise.Among them,the top three hospitalization expenses are material expenses,drug expenses and diagnosis expenses,accounting for 80.25%.However,the cost of comprehensive medical services reflecting the labor value of medical staff is low,which shows that the unreasonable composition of hospitalization expenses of elderly patients is still serious.The drug cost,material cost and diagnostic cost have a great contribution rate to the correlation and structural change of hospitalization expenses of elderly patients.They are the key factors that cause the change of hospitalization expenses of elderly patients with circulatory system diseases.Although the drug cost shows a downward trend year by year,the high proportion of drug cost in the composition of hospitalization expenses of patients cannot be ignored.Therefore,we should focus on strengthening the screening and diagnosis and treatment of high incidence and common diseases in the elderly population,optimize the hospitalization cost structure of elderly patients,analyze and discuss the controllable factors and formulate corresponding cost control measures to effectively reduce the economic burden of elderly patients. |
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