Chen Dajie, Liu Shuai, Tan Xiaodong, Zhao Qihan
Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
BMC Health Serv Res. 2017 Mar 14;17(1):199. doi: 10.1186/s12913-017-2140-4.
The incidence of type 2 diabetes is increasing, creating a huge burden for China's social healthcare system. This study aimed to evaluate hospital length of stay (LOS) based on admission characteristics and direct costs correlated with various types of complications for type 2 diabetic inpatients in Hubei Province, China.
A total of 1528 inpatients diagnosed with type 2 diabetes discharged between April 1, 2013, and March 31, 2014, were included in this study. Information regarding patients' admission and hospitalization were obtained from the hospital information system. The relationship between admission characteristics and LOS, distribution of total costs, and types of complications were described and analysed.
(1) The mean LOS was 11.65 days (median: 10 days). Multiple linear regression analysis demonstrated that inpatients with New Cooperative Medical Scheme (NCMS), aged 80 and above, had longer LOS than the reference group, and inpatients with chronic or acute + chronic complications had shorter LOS than those without. (2) Mean total costs per patient were US$159.72 ± 130.83 (median: US$135.33), US$240.60 ± 166.58 (median: US$192.09), and US$247.98 ± 166.22 (median: US$200.99) for inpatients with no complications, chronic complications, and acute + chronic complications, respectively. Total and individual costs were significantly less for patients without complications than for those with the two types of complications (p < 0.001). (3) Mean total costs per patient were US$225.40 ± 115.32 (median: US$200.34), US$221.25 ± 177.64 (median: US$170.05), and US$275.18 ± 193.14 (median: US$217.91) for inpatients with microvascular complications, macrovascular complications, and microvascular + macrovascular complications, respectively. Total costs were significantly higher for patients with microvascular + macrovascular complications than for those with other types of chronic complications (p < 0.001). (4) Drugs were the greatest expense for patients, and the least expensive treatment was nursing care.
Medical insurance status, age, and type of complication may help to predict LOS for patients with type 2 diabetes in Hubei Province, China. The total and individual costs for patients with complications were higher than for those without, and hospitalization expenses posed a heavy burden. Efforts should be made to reduce the financial impact on patients by integrating the medical insurance system of urban and rural areas, and by reducing the risk of complications, especially microvascular complications.
2型糖尿病的发病率不断上升，给中国社会医疗体系带来了巨大负担。本研究旨在基于入院特征以及与中国湖北省2型糖尿病住院患者各类并发症相关的直接费用，评估住院时长（LOS）。
本研究纳入了2013年4月1日至2014年3月31日期间出院的1528例确诊为2型糖尿病的住院患者。从医院信息系统获取患者入院及住院的相关信息。描述并分析入院特征与住院时长、总费用分布以及并发症类型之间的关系。
（1）平均住院时长为11.65天（中位数：10天）。多元线性回归分析表明，参加新型农村合作医疗（NCMS）且年龄在80岁及以上的住院患者住院时长比参照组更长，而患有慢性或急性加慢性并发症的住院患者住院时长比无并发症的患者更短。（2）无并发症、慢性并发症以及急性加慢性并发症的住院患者人均总费用分别为159.72美元±130.83美元（中位数：135.33美元）、240.60美元±166.58美元（中位数：192.09美元）和247.98美元±166.22美元（中位数：200.99美元）。无并发症患者的总费用和单项费用显著低于有这两种并发症的患者（p<0.001）。（3）患有微血管并发症、大血管并发症以及微血管加大血管并发症的住院患者人均总费用分别为225.40美元±115.32美元（中位数：200.34美元）、221.25美元±177.64美元（中位数：170.05美元）和275.18美元±193.14美元（中位数：217.91美元）。患有微血管加大血管并发症患者的总费用显著高于患有其他类型慢性并发症的患者（p<0.001）。（4）药品是患者最大的支出，最廉价的治疗是护理。
医疗保险状况、年龄和并发症类型可能有助于预测中国湖北省2型糖尿病患者的住院时长。有并发症患者的总费用和单项费用高于无并发症患者，住院费用带来沉重负担。应通过整合城乡医疗保险体系以及降低并发症风险，尤其是微血管并发症风险，努力减轻患者的经济负担。
