Study on the relationship between the proportion of medical expenses and the rationality of the hospitalization expense structure in chronic heart failure_West China Medical Journal

Authors：

 HE Zhen ¹ , ZHU Yuting ¹ ,  LI Ping ² , XIE Juan ³

1. School of Medicine, Tongji University, Shanghai 200090, P. R. China;
2. Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine, Shanghai 201200, P. R. China;
3. School of Public Health and Wellness, Guizhou Medical University, Guiyang 550025, P. R. China;

Corresponding?author：

LI Ping, Email: yiwuchulp@126.com

Keywords：

Hospitalization expense structure; reasonable evaluation of expenses; restricted cubic spline; chronic heart failure

DOI：

10.7507/1002-0179.202406148

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the relationship between the proportion of hospitalization expenses and the rationality of expense structure in patients with chronic heart failure (CHF), providing reference for early warning of unreasonable hospitalization expense structure and reasonable control of patients’ hospitalization expenses.Methods Patients with CHF between 2020 and 2023 in Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine were used as the study data. Percentile algorithm was used to judge the rationality of the hospitalization expense structure. Multivariate logistic regression model was used to analyze the correlation between the proportion and rationality of expense structure. Restricted cubic spline model was to analyze the threshold response relationship. Results A total of 762 patients were included. The medicine expenses remained the primary component of hospitalization expenses for patients with CHF, and combined expenses of examination and laboratory tests exceeded 80% of the total hospitalization expenses. The incidence of unreasonable hospitalization expense structure in patients with CHF was about 10%. The proportion of traditional Chinese medicine, western medicine, examination and laboratory tests, age, admission mode and clinical pathway were the influencing factors of unreasonable hospitalization expense structure in patients with CHF. After coordinating the relevant variables, when the proportion of examination and laboratory tests was <35%, the risk of unreasonable hospitalization expense structure decreased with the increase of the proportion [odds ratio=0.887, 95% confidence interval (0.805, 0.977), P<0.01]. While the proportion of western medicine expenses was >30%, the proportion of traditional Chinese medicine expenses was >13%, and the proportion of examination and laboratory tests was>35%, the risk of unreasonable hospitalization expense structure increased with the increase of proportion (P<0.01). Conclusions There is a correlation between the expense proportion of medicine, examination and laboratory tests and unreasonable hospitalization expense structure. The consumptive expenses should be reasonably controlled.

Citation： HE Zhen, ZHU Yuting, LI Ping, XIE Juan. Study on the relationship between the proportion of medical expenses and the rationality of the hospitalization expense structure in chronic heart failure. West China Medical Journal, 2024, 39(9): 1413-1418. doi: 10.7507/1002-0179.202406148 Copy

1.	張健, 張宇輝, 周蕾. 國家心力衰竭指南 2023(精簡版). 中國循環雜志, 2023, 38(12): 1207-1238.
2.	GBD 2017 disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1789-1858.
3.	Horiuchi Y, Asami M, Ide T, et al. Prevalence, characteristics and cardiovascular and non-cardiovascular outcomes in patients with heart failure with supra-normal ejection fraction: insight from the JROADHF study. Eur J Heart Fail, 2023, 25(7): 989-998.
4.	Huang J, Yin H, Zhang M, et al. Understanding the economic burden of heart failure in China: impact on disease management and resource utilization. J Med Econ, 2017, 20(5): 549-553.
5.	劉杰榮, 羅愛靜, 黃攀豪, 等. 基于大數據的單病種住院藥品費用合理性篩查實證研究. 醫學信息, 2018, 31(7): 10-13.
6.	中華人民共和國國家統計局. 中國統計年鑒. 北京: 中國統計出版社, 2023.
7.	李雅慧, 袁蕊, 劉雪嬌. 全髖關節置換術患者超高住院費用影響因素分析. 中國病案, 2023, 24(8): 72-75.
8.	中華中醫藥學會慢性心力衰竭中醫診療指南項目組. 慢性心力衰竭中醫診療指南(2022 年). 中醫雜志, 2023, 64(7): 743-756.
9.	張彭燕, 劉振球, 樊虹, 等. 限制性立方樣條 Cox 比例風險模型在腫瘤預后分析中的應用. 復旦學報(醫學版), 2023, 50(2): 280-285.
10.	趙德華, 龍小慶, 王繼生, 等. 基于限制性立方樣條分析抗腫瘤藥物與腫瘤患者 DRG 超支之間的相關性. 中國醫院藥學雜志, 2024, 44(13): 1580-1584.
11.	鄭昂, 孫樹, 王宇航. 藥品“零差率”后遼寧省某市乳腺癌患者治療費用變化分析. 中國衛生統計, 2023, 40(3): 405-407, 411.
12.	吳燕婷, 李萍, 吳寒. 藥品零加成政策對慢性心力衰竭患者次均住院費用變化影響結構分析. 現代預防醫學, 2021, 48(23): 4304-4306, 4344.
13.	中國心力衰竭中心聯盟專家委員會. 心力衰竭 SGLT2 抑制劑臨床應用的中國專家共識. 臨床心血管病雜志, 2022, 38(8): 599-605.
14.	徐朝輝, 鐘逸航, 史天云, 等. 芪附益心方治療慢性心力衰竭心氣虛證患者的臨床療效. 中國實驗方劑學雜志, 2023, 29(23): 98-105.
15.	許斯, 職晨陽. 2014-2016 年河南省三級甲等醫院出院患者平均住院日調查分析. 中國醫院, 2018, 22(8): 30-32.
16.	于洗河, 降海蕊, 賈歡歡, 等. 吉林省某三甲醫院心腦血管疾病患者住院費用影響因素分析. 醫學與社會, 2021, 34(2): 12-16.
17.	田葳, 張美琪, 王帥飛, 等. 233 例心力衰竭患者住院費用及影響因素分析. 中國病案, 2021, 22(4): 64-67.
18.	朱劍, 邊素艷, 劉姍姍, 等. 不同類型老年慢性心力衰竭患者心血管及非心血管慢性病負擔比較. 中華老年心腦血管病雜志, 2023, 25(3): 255-259.
19.	黃宇理, 姚慧強, 張先林, 等. 三甲醫院指導下社區慢性心力衰竭患者按分期管理的效果分析. 中華全科醫學, 2023, 21(6): 977-980, 1007.
20.	孫源, 劉括, 李冰瀟, 等. 糖尿病心血管并發癥預測模型的構建. 醫學新知, 2024, 34(1): 2-13.
21.	張欣悅, 李智, 楊平, 等. 臨床藥師參與重癥監護室重癥感染患者抗感染治療效果研究. 藥物流行病學雜志, 2024, 33(8): 877-883.
22.	顧曉敏, 劉暢. 基于結構變動度及灰色關聯的 DRG 付費對婦科腫瘤住院患者住院費用的影響. 中國藥師, 2024, 27(4): 622-630.

1. 張健, 張宇輝, 周蕾. 國家心力衰竭指南 2023(精簡版). 中國循環雜志, 2023, 38(12): 1207-1238.
2. GBD 2017 disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1789-1858.
3. Horiuchi Y, Asami M, Ide T, et al. Prevalence, characteristics and cardiovascular and non-cardiovascular outcomes in patients with heart failure with supra-normal ejection fraction: insight from the JROADHF study. Eur J Heart Fail, 2023, 25(7): 989-998.
4. Huang J, Yin H, Zhang M, et al. Understanding the economic burden of heart failure in China: impact on disease management and resource utilization. J Med Econ, 2017, 20(5): 549-553.
5. 劉杰榮, 羅愛靜, 黃攀豪, 等. 基于大數據的單病種住院藥品費用合理性篩查實證研究. 醫學信息, 2018, 31(7): 10-13.
6. 中華人民共和國國家統計局. 中國統計年鑒. 北京: 中國統計出版社, 2023.
7. 李雅慧, 袁蕊, 劉雪嬌. 全髖關節置換術患者超高住院費用影響因素分析. 中國病案, 2023, 24(8): 72-75.
8. 中華中醫藥學會慢性心力衰竭中醫診療指南項目組. 慢性心力衰竭中醫診療指南(2022 年). 中醫雜志, 2023, 64(7): 743-756.
9. 張彭燕, 劉振球, 樊虹, 等. 限制性立方樣條 Cox 比例風險模型在腫瘤預后分析中的應用. 復旦學報(醫學版), 2023, 50(2): 280-285.
10. 趙德華, 龍小慶, 王繼生, 等. 基于限制性立方樣條分析抗腫瘤藥物與腫瘤患者 DRG 超支之間的相關性. 中國醫院藥學雜志, 2024, 44(13): 1580-1584.
11. 鄭昂, 孫樹, 王宇航. 藥品“零差率”后遼寧省某市乳腺癌患者治療費用變化分析. 中國衛生統計, 2023, 40(3): 405-407, 411.
12. 吳燕婷, 李萍, 吳寒. 藥品零加成政策對慢性心力衰竭患者次均住院費用變化影響結構分析. 現代預防醫學, 2021, 48(23): 4304-4306, 4344.
13. 中國心力衰竭中心聯盟專家委員會. 心力衰竭 SGLT2 抑制劑臨床應用的中國專家共識. 臨床心血管病雜志, 2022, 38(8): 599-605.
14. 徐朝輝, 鐘逸航, 史天云, 等. 芪附益心方治療慢性心力衰竭心氣虛證患者的臨床療效. 中國實驗方劑學雜志, 2023, 29(23): 98-105.
15. 許斯, 職晨陽. 2014-2016 年河南省三級甲等醫院出院患者平均住院日調查分析. 中國醫院, 2018, 22(8): 30-32.
16. 于洗河, 降海蕊, 賈歡歡, 等. 吉林省某三甲醫院心腦血管疾病患者住院費用影響因素分析. 醫學與社會, 2021, 34(2): 12-16.
17. 田葳, 張美琪, 王帥飛, 等. 233 例心力衰竭患者住院費用及影響因素分析. 中國病案, 2021, 22(4): 64-67.
18. 朱劍, 邊素艷, 劉姍姍, 等. 不同類型老年慢性心力衰竭患者心血管及非心血管慢性病負擔比較. 中華老年心腦血管病雜志, 2023, 25(3): 255-259.
19. 黃宇理, 姚慧強, 張先林, 等. 三甲醫院指導下社區慢性心力衰竭患者按分期管理的效果分析. 中華全科醫學, 2023, 21(6): 977-980, 1007.
20. 孫源, 劉括, 李冰瀟, 等. 糖尿病心血管并發癥預測模型的構建. 醫學新知, 2024, 34(1): 2-13.
21. 張欣悅, 李智, 楊平, 等. 臨床藥師參與重癥監護室重癥感染患者抗感染治療效果研究. 藥物流行病學雜志, 2024, 33(8): 877-883.
22. 顧曉敏, 劉暢. 基于結構變動度及灰色關聯的 DRG 付費對婦科腫瘤住院患者住院費用的影響. 中國藥師, 2024, 27(4): 622-630.

West China Medical Journal

Study on the relationship between the proportion of medical expenses and the rationality of the hospitalization expense structure in chronic heart failure

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content