Application Status And Cost Estimation Of Continuous Renal Replacement Therapy In Wuhan

Objective:To understand the application status of continuous renal replacement therapy(CRRT)in public hospitals in Wuhan.Analysis the cost composition and cost recovery of CRRT treatment.To explore the influential factor in the process of cost formation.To provide the basis for determining the reasonable payment standards.Objects and methods:1.Research object:Take all public hospitals in Wuhan as the research object,which using CRRT in 2016.2.Research contents:(1)Application status of CRRT:The frequency,duration,anticoagulant usage and routine matching examination of CRRT equipment in various departments of public hospitals in Wuhan were analyzed.(2)CRRT cost components:The understanding of the CRRT cost by the stakeholders.Take a hospital with a large business volume as an example to analyze the formation process and cost structure of CRRT treatment cost.3.Research methods:(1)Qualitative research:Through literature research,we understand the application of CRRT technology at home and abroad.On this basis,we conduct several rounds of expert discussion to determine the components and calculation principles of CRRT cost.Interviews were conducted among stakeholders to understand their cognition of CRRT cost formation and suggestions for pricing and charging.Thematic analysis was used to sort out the interview content.(2)Quantitative study:Using a self-made questionnaire to investigate.(3)Statistical analysis method:Using activity based costing to calculate the cost of CRRT treatment,analysis the unit cost and cost composition,discussing on the factors of cost influence and the cost difference between departments.Analysis of unit cost recovery under current charging standard.The formula is:cost recovery rate =current unit charge standard/unit cost)*100%,the smaller the value,the lower the cost recovery.(4)Quality Control:Training the survey members to ensure that the questionnaire is consistent with the calibre,the data is arranged strictly according to the requirements,and the form of double entry is adopted in order to ensure the authenticity and effectiveness of the data.Results:1.Basic situation:There are 23 public health institutions in Wuhan provide CRRT services,including 23 nephrology departments of 18 public medical institutions and 23 ICU services.2.CRRT application:①The above institutions have 86 CRRT devices,including 50 nephrology and 36 ICU.②The average opening number of all the equipment was 3 times per week,of which the average duration of the opening of the nephrology department and ICU was 8.2h and 19.1h,and the length of the filter replacement was 7.7h and 14.0h,respectively.③ In medical institutions,anticoagulants are more commonly used in low molecular weight heparin anticoagulation(nephrology 77.8%,ICU43.5%)and heparin anticoagulation(22.2%,ICU34.8%).④ CRRT routine treatment includes blood electrolyte examination,renal function test and blood gas analysis three items.Among them,the interval between the blood and electrolytes was 7 hours in the nephrology and 6.2h in ICU;the renal function interval was 8.4h and 16.5h in the Nephrology;the blood gas analysis interval was 8.2h in the nephrology and 5.2h in ICU.3.Cost estimation:① According to the activity-based costing,CRRT cost components include human cost,low cost cost,training cost,equipment depreciation cost,equipment maintenance cost,equipment operation cost,liquid cost(replacement liquid,dialysis liquid),consumables cost(filter + pipeline),anticoagulation cost,inspection cost and so on ten items.Among them,the average daily cost of treatment is 2811.1 yuan/day in the Department of Nephrology and 5009.1 yuan per day in ICU.The unit cost of treatment is 351.4 yuan/h in the Department of Nephrology and 208.8 yuan/h in ICU.②In the unit cost composition,the nephrology department was in turn the cost of 152.8 yuan/h(43.5%),the cost of equipment maintenance 52.7 yuan/h(15%),and the anticoagulant cost 43.5 yuan/h(12.4%);ICU was 64.1 yuan/h(30.7%),the cost of consumables 53.1 yuan/day(25.4%),and the cost of anticoagulation by 27.5 yuan/day(13.2%).4.Cost factors:Including the number of patients per unit time,the number of treatments per person,the duration of treatment,etc.5.Analysis on department cost recovery:Under the current charging condition in Wuhan,The unit cost recovery rate of CRRT in nephrology was 40.5%,lower than 61.4%of ICU.Conclusion:There are differences among the departments of CRRT techno logy application in Wuhan,and there are great differences in frequency and du ration of use.The cost recovery rate of CRRT treatment in nephrology is lowe r than that of ICU.The proportion of liquid cost,consumable cost and anticoa gulation cost is high.