Analysis Of The Structure And Influencing Factors Of Single Disease Hospitalization Costs In A Tertiary Hospital Based On Clinical Pathway

Objective: To study the four single diseases of nodular goiter,gallbladder stones with chronic cholecystitis,uterine leiomyoma and vocal cord polyps in a top three hospital in hunan province,and to investigate whether or not to include the clinical path before paying for a single disease.the difference between the patient's medical expenses,the structure of medical expenses and the factors affecting medical expenses,and the difference between the per capita hospitalization cost of patients included in the clinical pathway and the single-patient payment quota standard provide reference for further implementation and improvement of single-patient payment.Methods: The hospitalization cost information and the medical record home page information of four patients were derived from the HIS system of a top three hospital in Hunan Province.The time span was from September 2016 to June 2018,and the clinical path was not included in the control group.The path is the experimental group.Using Excel 2010 for data entry,using SPSS 19.0 for single-sample t-test,two independent sample t-test,chi-square test,rank sum test and one-way ANOVA for data analysis,and to explore China's single-case payment system through interviews There are problems.Result:(1)The hospitalization cost of nodular goiter included in the clinical path decreased by 483.59±445.07 yuan(P<0.05),the per capita hospitalization cost of gallbladder stones with chronic cholecystitis decreased by 2821.37±2144.15 yuan(P<0.05),and the hospitalization cost of uterine leiomyoma per capita The decrease was 1057.37±697.67 yuan(P<0.05),and the per capita hospitalization cost of vocal cord polyps decreased by 209.96±94.37 yuan(P<0.05).(2)The per capita hospitalization cost of single-patients included in the clinical pathway was compared with the single-category fee standard of the single disease type.The average hospitalization expenses of the three single-species patients with nodular goiter,vocal cord polyps and uterine leiomyoma were It is higher than the single-type one-type charging standard corresponding to the place,and P<0.05,which is statistically different.The per capita hospitalization cost of patients with cholecystolithiasis and chronic cholecystitis included in the clinical path was lower than that of the corresponding single disease type in the place,and P<0.05,with statistical difference.(3)The hospitalization cost of the four single diseases of nodular goiter,gallbladder stones with chronic cholecystitis,uterine leiomyoma,and vocal cord polyps included in the clinical path was compared with that of patients not included in the clinical pathway.Cost and examination costs decreased,surgery costs and treatment costs increased,and P < 0.05,with statistical differences.In terms of the proportion of hospitalization expenses,the proportion of drug expenses,inspection fees,laboratory fees,and other expenses decreased,and the proportion of surgery fees,treatment fees,nursing expenses,bed fees,and anesthesia fees increased.(4)After two independent sample t-test and one-way analysis of variance,the influencing factors of hospitalization expenses were not consistent in the patients who were not included in the clinical pathway group and those who were included in the clinical pathway group.The common influencing factors were hospital admission and hospitalization days.(5)Payment by single disease type is the primary form of payment according to the disease type.There are problems such as excessively rigid promotion methods,difficulty in effectively coping with disease variability,unreasonable compensation mechanism,“reverse selection” by doctors,and unclear clinical pathway design standards.Conclusion: The implementation of clinical pathway reduces the hospitalization cost of patients with nodular goiter,gallbladder stones with chronic cholecystitis,uterine leiomyoma and vocal cord polyps.The hospitalization cost structure is optimized to a certain extent,and the hospitalization expenses are affected.The factors are stable.However,the per capita hospitalization cost of patients is significantly higher than the single disease standard,indicating that the implementation of payment for single disease faces many problems that need to be solved urgently.