The Economic Burden Of Inpatients With In-hospital Falls And Out-hospital Falls

Objectives:1.To understand the economic burden of disease caused by falls in Chongqing area,and to provide evidence to pay attention to fall prevention work from the perspective of economics;2.Based on the Tobit regression model,the influencing factors of the direct medical economic burden related to in-hospital falls were analyzed,so as to provide data support for reducing the economic burden of disease in patients with in-hospital falls.3.Based on the quantile regression model,the influencing factors of the direct medical economic burden of hospitalized patients with falls were analyzed,and a grouping model of the direct medical economic burden was built with the help of CHAID decision tree model,so as to put forward suggestions for reducing the economic burden of out-hospital falls.Methods:1.Investigation on the economic burden of in-hospital falls and analysis of influencing factors in direct medical economic burden(1)Investigation on the economic burden of in-hospital falls: Patients who occurred in-hospital falls during 2016 to 2018 were selected through the adverse events reporting system of a large Grade-A tertiary hospital in Chongqing,and retrospective study was conducted to understand the economic burden of in-hospital falls through the adverse events reporting system,information system,electronic medical records management system and medical insurance system.(2)Analysis of influencing factors in direct medical economic burden based on Tobit regression model: Descriptive analysis was conducted on basic information and the composition of economic burden of disease,and Tobit regression model was used to analyze the influencing factors of direct medical economic burden related to in-hospital falls.2.Investigation on the economic burden of out-hospital falls and analysis of influencing factors in direct medical economic burden(1)Investigation on the economic burden of out-hospital falls:Patients hospitalized for falls during 2016 to 2019 were selected as research objects through the information system of two large Grade-A tertiary hospitals in Chongqing,and with the help of hospital electronic medical record system and medical insurance information system to carry out retrospective investigation of direct medical economic burden.Questionnaires were used to investigate the direct non-medical economic burden,indirect economic burden and intangible economic burden in some patients hospitalized due to falls.(2)Analysis of influencing factors in direct medical economic burden based on quantile regression model and decision tree model: Descriptive analysis was conducted on basic information and the structure of economic burden.On the basis of univariate analysis,quantile regression model was used to select the classification node variables included in the decision tree,and influential variables were included in the CHAID decision tree model to establish a grouping model of direct medical economic burden.Results:1.Investigation on the economic burden of in-hospital falls and analysis of influencing factors in direct medical economic burden(1)Investigation on the economic burden of in-hospital falls: In this study,in-hospital falls are most frequently occurred in the department of geriatrics and neurosurgery,and common place for falls was beside the bed or the bathroom.The total direct medical economic burden related to in-hospital fall of 290 patients was 682 180.32 yuan,with cost of consumables,diagnosis and medicine as main components.The medical insurance fund paid 74.74%.Compared to the control group,the length of stay was increased due to the grade Ⅲ fall injuries,and the indirect economic burden was increased by 110.25 yuan on average.(2)Analysis of influencing factors in direct medical economic burden based on Tobit regression model: The results of single factor analysis showed that the direct medical economic burden affected by nurses’ working years,the place of falls occured,injury degree,number of injury sites,age,work status and ward type,and the results of the Tobit regression model analysis showed that the degree of falls injury had a significant impact on direct medical economic burden of in-hospital falls(P<0.05).2.Investigation on the economic burden of out-hospital falls and analysis of influencing factors in direct medical economic burden(1)Investigation on the economic burden of out-hospital falls: In this study,patients were distributed in department of orthopedics and neurosurgery,the total direct medical economic burden of 6 627 patients due to falls was 334 812 366.25 yuan,with consumable cost as the main component,the medical insurance fund paid 49.80%.The average direct non-medical economic burden of the patients who received questionnaire was 2 413.97 yuan,and employment cost account for a high proportion.The average indirect economic burden was 1 3802.83 yuan.The effect of willingness to pay method on intangible economic burden assessment is related to respondents’ understanding of problems.(2)Analysis of influencing factors in direct medical economic burden based on quantile regression model and decision tree model: The results of single factor analysis showed that payment method,work,marriage,age,length of stay,wound position and type,operation times and type had effects on direct medical economic burden of patients hospitalized for falls.The quantile regression analysis showed that payment method,marriage,age,length of stay,position and type of wound,times and type of operation had significant influence on different subpoints of hospitalization costs(P < 0.05).In the cost grouping model established by the quantile regression model combined with the CHAID decision tree model,the times and type of operation,length of stay,position and type of wound were the most important influencing factors,and the cost of each combination was significantly different.Conclusions:1.Falls tend to occur in the elderly,placing economic burden on patients,families and the health insurance funds,which reminds medical workers and elderly patients to pay attention on falls prevention.2.The direct medical economic burden of patients with in-hospital falls is related to the degree of injury,and the direct medical economic burden of patients hospitalized for falls is mainly affected by the operation times and type,length of stay,wound position and type,and the cost grouping model can clearly reflect the influence path of factors.According to the influencing factors,targeted comprehensive preventive measures should be taken to help reduce the economic burden of falls.