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中国中型城市脑梗死患者入院特征、住院时间和费用评估。

Evaluation of admission characteristics, hospital length of stay and costs for cerebral infarction in a medium-sized city in China.

机构信息

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong Department of Forensic Medicine, North Sichuan Medical College, Nanchong, P. R. China.

出版信息

Eur J Neurol. 2010 Oct;17(10):1270-6. doi: 10.1111/j.1468-1331.2010.03007.x.

Abstract

BACKGROUND AND PURPOSE

Stroke is a heavy economic and health burden for the patients and society. This study aimed to evaluate hospital length of stay (LOS) by admission characteristics and costs correlated with medical insurance status for cerebral infarction in a medium-sized city in China.

METHODS

A total of 557 consecutive patients with principal diagnosis of cerebral infarction were enrolled. Admission characteristics, LOS, and costs were retrospectively analyzed.

RESULTS

The mean LOS was 18.5 days (median, 16 days). Our analysis demonstrated that medical insurance status, stroke severity (National Institutes of Health Stroke Scale score, Functional Independence Measure cognitive and motor score, Glasgow coma scale), Oxfordshire Community Stroke Project (OCSP) classification, some comorbidities (coronary heart disease, chronic obstructive pulmonary disease, and hyperlipemia), and raised leukocytes were the main explanatory factors for LOS by stepwise multiple regression model. The mean per patient costs were US $983.0, and mean daily costs US $67.0. Drugs were the most expensive cost subtype, all subtypes costs except non-medical care were significantly higher in patients with state medicine than in those with new cooperative medical scheme (NCMS) (P < 0.001).

CONCLUSION

Stroke severity, OCSP classification, raised leukocytes on admission, some comorbidities, and medical insurance status may help to predict LOS for patients with cerebral infarction. Healthcare expenditures were heavy burdens to inhabitants. State medicine patients could shorten unnecessary LOS to improve the resources allocation and cost-efficiency.

摘要

背景与目的

脑卒中给患者及其家庭、社会带来了沉重的经济和健康负担。本研究旨在评估中国中部某城市脑梗死患者的住院时间(LOS)与医疗保险状态相关的费用。

方法

共纳入 557 例以脑梗死为主要诊断的连续患者。回顾性分析了入院特征、LOS 和费用。

结果

平均 LOS 为 18.5 天(中位数,16 天)。多因素逐步回归分析显示,医疗保险状态、卒中严重程度(NIHSS 评分、FIM 认知和运动评分、GCS)、OCSP 分类、一些合并症(冠心病、慢性阻塞性肺疾病、高脂血症)和入院时白细胞升高是 LOS 的主要解释因素。每位患者的平均费用为 983.0 美元,日均费用为 67.0 美元。药物是最昂贵的费用类型,除非医疗护理外,所有类型的费用在全民医保患者中均显著高于新型农村合作医疗患者(P<0.001)。

结论

卒中严重程度、OCSP 分类、入院时白细胞升高、一些合并症和医疗保险状态可能有助于预测脑梗死患者的 LOS。医疗保健支出是居民的沉重负担。全民医保患者可以缩短不必要的 LOS,以改善资源配置和成本效益。

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