Study On Hospitalization Cost Of Patients With Pulmonary Tuberculosis And Its Influencing Factors

Objectives: The quality of medical service and the trend of medical economy in our country largely depend on the cost of hospitalization.Scientific management is indispensable to the exploration and promotion of single-disease payment model.We aim to analyze the basic situation of hospitalization expenses for tuberculosis patients from 2012 to 2017,and explore its influencing factors,in order to put forward feasible suggestions for improving the management of tuberculosis expenses.Methods: Information of hospitalization expenses of patients with pulmonary tuberculosis from 2012 to 2017 and related factors were collected in a hospital of Tianjin.Based on the descriptive analyses,the related factors of hospitalization costs were analyzed by multiple linear regression method and new grey relational analysis.Using the degree of structure variation analysis method to evaluate The changes of hospitalization expense in the six years and the impact of each item on the total hospitalization cost were analyzed by using the method of structure variation degree analysis.The effectiveness of clinical pathway management was explored by means of comparing the expenses of patients hospitalizd before and after December2016 when the clinical pathway management was implemented.In addition,the cognition situation of the clinical pathway management was investigated among the medical staff.Results: A total of 14 662 tuberculosis patients were included in the study,of whom10 156 males and 4506 females,and median(IQR)of age was 51(34))years.The median(IQR)of hospitalization days was 12(6)days.The median(IQR)of hospitalization cost was 12581.67(7398.57)yuan.The results of multivariate linear stepwise regression analysis showed that the main factors affecting hospitalization expenses were hospital day,drug proportion,blood transfusion,operation,outcome of disease,admission status,year of hospitalization,sex,mode of medical payment and age.The new grey relational analysis showed that the top five factors affecting the total hospitalization cost are inspection fee(0.9638),medicine fee(0.9629),treatment fee(0.7465),material fee(0.7443),bed fee(0.7416).The analysis of structural change degree showed the structural change rate of drug fee to expenditure is 50%, whit a negative change,followed by inspection fee(26.78%),treatment fee(8.03%)and nursing fee(4.07%),whit a positive change.The median hospitalization days and the median hospitalization expenses were 13(7)days and 12714.85(6517.34)yuan,and 12(6)days and 12074.26(6536.68)yuan before and after clinical pathway management,respectively.,The differences were statistically significant by nonparametric test.The drug proportion of pulmonary tuberculosis patients before clinical pathway management was 41.81%,and that after clinical pathway management was 39.73%,and the difference was statistically significant after t-test.Conclusion: Reasonable reduction of average hospitalization days,drug proportion of tuberculosis patients,implementation of clinical pathway management at the hospital level,enhancing medical staff's' awareness of clinical pathway management,can ensure the quality of medical care and reduce medical costs.At the same time,strengthening the management of medicines cost,inspection cost and material costs,so as to rationally adjust the internal structure of hospitalization expenses of tuberculosis patients.