Analysis of Factors on Expense in 1969 Cases of Stroke Inpatients_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Xiao feng ¹² , ZENG Qing ³ , LI You ping ¹ , ZHANG Xue feng ²

1. Chinese Evidence Based Medicine Centre; West China Hospital; Sichuan University; Chengdu 610041; China2. Department of Preventive Medicine; North Sichuan Medical College; Nanchong 6370073. Department of Health Statistics; Chongqing Medical University; Chongqing 400016;

Corresponding?author：

Keywords：

Inpatients expense; Stroke; Factors

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Objective 　To provide references to control the cost of stroke inpatients by analysing pertinent factors of stroke inpatients.
Methods 　According to the models of Anderson and Newnan, univariable analysis and multivariable statistical analysis were applied to a number of factors including predisposing factors, enabling factors, and needs factors in 1 969 stroke inpatients of two third level first-class hospitals in Chongqing.
Results 　Among the 1 969 stroke inpatients, 64% had a history of hypertension, and 50% exhibited hypertension during their stay in hospital. Expenditure on medication consumed the highest costs (51%). Length of stay was the most important factor affecting inpatient expense, additional factors were number of surgical operation, nurse type, Rankin score, number of complications etc.
Conclusions 　Complex measures focusing on hypertension to prevent and control of stroke are recommended. Reducing unnecessary stay in hospital and appropriate prescribing are important methods to reduce cost of stroke inpatients.

Citation： GAO Xiao feng,ZENG Qing,LI You ping,ZHANG Xue feng. Analysis of Factors on Expense in 1969 Cases of Stroke Inpatients. Chinese Journal of Evidence-Based Medicine, 2005, 05(2): 110-116. doi: Copy

1.	腦卒中發病位居全球第二, 發病呈南低北高之勢[Z]. Available from: URL: http://www.haowawa.com/A4/2003-11-06/A40503200311061030200000.asp.
2.	戚少華. 老年腦卒中危險因素的研究[J]. 老年醫學與保健, 2002;8(3): 140～143.
3.	張紅葉, 楊軍, 周北凡, 武陽豐, 李瑩, 陶壽淇. 我國十組人群腦卒中危險因素的前瞻性研究[J]. 中國慢性病預防與控制, 1996;4(4): 150～152,172.
4.	王文. 抗高血壓臨床試驗. 見劉力生, 主編. 高血壓[M]. 第1版. 北京: 人民衛生出版社, 2001.p. 1 297～ 1 325.
5.	王文, 劉力生. 血壓水平與腦卒中再發的關系--1 520例腦血管病患者隨訪4年[J]. 高血壓雜志, 2003;11(2): 106～108.
6.	王文, 鄧卿, 何華, 馬麗媛. 降壓治療對腦卒中二級預防的臨床證據[J]. 中國循證醫學雜志, 2004;4(5): 355～358.
7.	專家論壇: 直面健康貧困[Z]. Available from: URL:http://www.lsinfo.gov.cn/shownews.asp?NewsID=6694(2003-08-19).
8.	腦卒中: 治療+康復訓練最經濟[Z]. Available from: URL:http://www.chinaneurosurgery.net/nous/nxgb/nzzzl.htm.(2003-11-26).
9.	劉鳴. 循證醫學與臨床實踐[J]. 中國循證醫學雜志, 2001;1(1): 8～9.
10.	李繼光, 侯桂春. 我院降低藥品收費構成比及有關的醫療經濟分析[J]. 中華醫院管理雜志, 2003;19(2): 104～106.
11.	馬謝民, 英立平, 鐘軍, 張丹. 常見手術病種住院流程重組與縮短平均住院日的研究[J]. 中華醫院管理雜志, 1999;15(10): 603～604.
12.	王霞, 郭秀娥, 徐勇勇, 潘峰, 劉理. 住院患者無效住院日的存在狀況及其影響因素[J]. 第四軍醫大學學報, 2001;22(6): 557～559.
13.	王玖, 徐天和, 唐軍, 祁愛琴, 石德文. 兩單病種住院病人不必要醫療費用分析[J]. 衛生經濟研究, 2002;(7): 21～22.
14.	馬旭升. 病種住院日和醫療費用分析及影響因素[J]. 解放軍管理雜志, 2002;9(1): 78～80.
15.	高曉鳳, 曾慶, 段云. 卒中病人住院費用影響因素的遞歸系統模型分析[J]. 中國衛生統計, 2003;20(6): 332～334.
16.	馬娟, 白紅, 肖福坤. DRGs在醫院改革中應用的可行性分析[J]. 中國衛生事業管理, 1991;7(10): 472～474.
17.	鐘潔珍, 向月應, 王慶林. 醫療保險中實施DRGs的探討[J]. 中國衛生經濟, 2001;20(2): 49.
18.	徐輝, 姜秀琴, 王彥昌. 論"DRGs-PPS"在我國醫院管理改革中應用的適合度[J]. 中國醫院管理, 1991;11(1): 59～63.
19.	Neto JIS, Santos AC, Fabio SR ,Sakamoto AC. Cerebral infarction in patients ages 15 to 40 years[J]. Stroke, 1996;27(11): 2 016- 2 019.
20.	Incidence of stroke rank second in all diseases of the world, appearing tendency of high rate in north and low rate in south.
21.	Hazards of stroke. 腦卒中(中風)的危害[Z]. Available from: URL: http://health.sohu.com/2004-09-21/n222156293.shtml.
22.	Roberts H, Khee TS, Philip I. Setting priorities for measures of performance for geriatric medical services[J]. Age ageing, 1994;23(2): 154.
23.	Anderson R, Newman JF. Societal and individual determinants of medical care utilization in care utilization in the United States[J]. The Milbank Memorial Fund Quarterly, 1973;51: 95-124.
24.	Qi SH. The study on risk factors of stroke in agedness[J]. Geriatr Health Care, 2002;8(3): 140-143.
25.	Anonymous.Prospective studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts[J]. Lancet, 1995;346 (8 991-8 992): 1 647- 1 653.
26.	Zhang HY, Yang J, Zhou BF, Wu YF, Li Y, Tao SQ. Prospective study of risk factors about stroke in 10 groups of people[J]. Chin J Prev Contr Chron Non-commun Dis, 1996;4(4): 150-152, 172.
27.	MacMahon S, Peto R, Cutler J ,Collins R, Sorlie P, Neaton R, Abbot R, Godwin J, Dye A, Stamler J. Blood pressure, stroke, coronary heart disease;PartⅠ, Prolonged difference in blood pressure;Prospective observational studies corrected for the regression dilution bias[J]. Lancet, 1990;335(8 692): 765-774.
28.	Anonymous,Eastern Stroke and Coronary Heart Disease Collaboration Research Croup. Blood pressure, cholesterol and stroke in eastern Asia[J]. Lancet, 1998;352(9 143): 1 801- 1 807.
29.	Wang W. clinic trial of anti-hypertension, see Liu LS, chief editor: hypertension[M]. Beijing: The People Health Publishing Company. 1st edtion, 2001. p. 1 297- 1 325.
30.	MacMahon S, Rodgers A, Neal B, Charmers J. Blood pressure lowering for the secondary United prevention of myocardial infarction and stroke[J]. Hypertension, 1997;29(2): 537-538.
31.	Rodgers A, MacMahon S, Gamble G,Slattery J, Sandercock P, Warlow C. The United Kingdom Transient Ischaemic Attack Collaborative Group. Blood pressure and risk of stroke in patients with cerebrovascular disease[J]. BMJ, 1996;313(7 050): 147.
32.	Wang W, Liu LS. The relation between blood pressure level and stroke recrudescence-1 520 vascular diseases patients were followed 4 years[J]. Chinese Journal of Hypertension, 2003;11(2): 106-108.
33.	Wang W, Den Q, He H, Ma LY. Clinic evidence for treatment of underpressure to stroke secondary prevention[J]. Chinese J Evidence-Based Medicine, 2004;4(5): 355-358.
34.	Specialist forum: facing health poverty.
35.	Sroke: cure with rehabilitation training is most economical.
36.	Liu M. Evidence-based medicine and clinic practice[J]. Chinese J Evidence-Based Medicine, 2001;1(1): 8-9.
37.	Li JG, Hou GC. Fall of medicine proportion and related economic analysis in my hostpital[J]. Chin J hosp Admin, 2003;19(2): 104-106.
38.	Ma XM, Ying LP, Zhong J, Zhang D. The study on regrouping flow of common surgery disease and shortening average stay days[J]. Chin J hosp Admin, 1999;15(10): 603-604.
39.	van Straten A, van der Meulen JH, van den Bos GA, Limburg M. Length of hospital stay and discharge delays in stroke patients[J]. Stroke, 1997;28(1): 137-140.
40.	Evers S, Voss G, Nieman F, Ament A, Groot T, Lodder J, Boreas A, Blaauw G. Predicting the cost of hospital stay of stroke patients: the use of diagnosis of related groups[J]. Health Policy, 2002;61(1): 21-42.
41.	Wang X, Guo XE, Xu YY, Pan F, Liu L. State of non-value-adding patient days and affected factors[J]. J Fourth Mil Med Univ, 2001;22(6): 557-559.
42.	Wang J, Xu TH, Tang J , Qi AQ, Shi DW. Medical expense analysis in two kinds diseases inpatients[J]. Health Economic Research, 2002;(7): 21-22.
43.	Ma XS. Analysis of stay days, medical expense and affected factors[J]. Hospital Administration Journal of Chinese People’s Liberation Army, 2002;9(1): 78-80.
44.	Gao XF, Zeng Q, Duan Y. Analysis of factors affected on the cost of hospital stay for stroke inpatients by recursive structural model[J]. Chinese Journal of Health Statistics, 2003;20(6): 332-334.
45.	Ma J, Bai H, Xiao FK. Feasibility analysis of applying DRGs to hospital reform[J]. Chinese Health Enterprise Management, 1991;7(10): 472-774.
46.	Zhong JZ, Xiang YY, Wang QL. Discuss applying DRGs to medical assurance[J]. Chinese Health Economy, 2001;20(2): 49.
47.	Xu H, Jiang XQ, Wang YC. Discuss the fit degree of applying "DRGs-PPS" to hospitals management reform in China[J]. Chinese Hospital Management, 1991;11(1): 59-63.

1. 腦卒中發病位居全球第二, 發病呈南低北高之勢[Z]. Available from: URL: http://www.haowawa.com/A4/2003-11-06/A40503200311061030200000.asp.
2. 戚少華. 老年腦卒中危險因素的研究[J]. 老年醫學與保健, 2002;8(3): 140～143.
3. 張紅葉, 楊軍, 周北凡, 武陽豐, 李瑩, 陶壽淇. 我國十組人群腦卒中危險因素的前瞻性研究[J]. 中國慢性病預防與控制, 1996;4(4): 150～152,172.
4. 王文. 抗高血壓臨床試驗. 見劉力生, 主編. 高血壓[M]. 第1版. 北京: 人民衛生出版社, 2001.p. 1 297～ 1 325.
5. 王文, 劉力生. 血壓水平與腦卒中再發的關系--1 520例腦血管病患者隨訪4年[J]. 高血壓雜志, 2003;11(2): 106～108.
6. 王文, 鄧卿, 何華, 馬麗媛. 降壓治療對腦卒中二級預防的臨床證據[J]. 中國循證醫學雜志, 2004;4(5): 355～358.
7. 專家論壇: 直面健康貧困[Z]. Available from: URL:http://www.lsinfo.gov.cn/shownews.asp?NewsID=6694(2003-08-19).
8. 腦卒中: 治療+康復訓練最經濟[Z]. Available from: URL:http://www.chinaneurosurgery.net/nous/nxgb/nzzzl.htm.(2003-11-26).
9. 劉鳴. 循證醫學與臨床實踐[J]. 中國循證醫學雜志, 2001;1(1): 8～9.
10. 李繼光, 侯桂春. 我院降低藥品收費構成比及有關的醫療經濟分析[J]. 中華醫院管理雜志, 2003;19(2): 104～106.
11. 馬謝民, 英立平, 鐘軍, 張丹. 常見手術病種住院流程重組與縮短平均住院日的研究[J]. 中華醫院管理雜志, 1999;15(10): 603～604.
12. 王霞, 郭秀娥, 徐勇勇, 潘峰, 劉理. 住院患者無效住院日的存在狀況及其影響因素[J]. 第四軍醫大學學報, 2001;22(6): 557～559.
13. 王玖, 徐天和, 唐軍, 祁愛琴, 石德文. 兩單病種住院病人不必要醫療費用分析[J]. 衛生經濟研究, 2002;(7): 21～22.
14. 馬旭升. 病種住院日和醫療費用分析及影響因素[J]. 解放軍管理雜志, 2002;9(1): 78～80.
15. 高曉鳳, 曾慶, 段云. 卒中病人住院費用影響因素的遞歸系統模型分析[J]. 中國衛生統計, 2003;20(6): 332～334.
16. 馬娟, 白紅, 肖福坤. DRGs在醫院改革中應用的可行性分析[J]. 中國衛生事業管理, 1991;7(10): 472～474.
17. 鐘潔珍, 向月應, 王慶林. 醫療保險中實施DRGs的探討[J]. 中國衛生經濟, 2001;20(2): 49.
18. 徐輝, 姜秀琴, 王彥昌. 論"DRGs-PPS"在我國醫院管理改革中應用的適合度[J]. 中國醫院管理, 1991;11(1): 59～63.
19. Neto JIS, Santos AC, Fabio SR ,Sakamoto AC. Cerebral infarction in patients ages 15 to 40 years[J]. Stroke, 1996;27(11): 2 016- 2 019.
20. Incidence of stroke rank second in all diseases of the world, appearing tendency of high rate in north and low rate in south.
21. Hazards of stroke. 腦卒中(中風)的危害[Z]. Available from: URL: http://health.sohu.com/2004-09-21/n222156293.shtml.
22. Roberts H, Khee TS, Philip I. Setting priorities for measures of performance for geriatric medical services[J]. Age ageing, 1994;23(2): 154.
23. Anderson R, Newman JF. Societal and individual determinants of medical care utilization in care utilization in the United States[J]. The Milbank Memorial Fund Quarterly, 1973;51: 95-124.
24. Qi SH. The study on risk factors of stroke in agedness[J]. Geriatr Health Care, 2002;8(3): 140-143.
25. Anonymous.Prospective studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts[J]. Lancet, 1995;346 (8 991-8 992): 1 647- 1 653.
26. Zhang HY, Yang J, Zhou BF, Wu YF, Li Y, Tao SQ. Prospective study of risk factors about stroke in 10 groups of people[J]. Chin J Prev Contr Chron Non-commun Dis, 1996;4(4): 150-152, 172.
27. MacMahon S, Peto R, Cutler J ,Collins R, Sorlie P, Neaton R, Abbot R, Godwin J, Dye A, Stamler J. Blood pressure, stroke, coronary heart disease;PartⅠ, Prolonged difference in blood pressure;Prospective observational studies corrected for the regression dilution bias[J]. Lancet, 1990;335(8 692): 765-774.
28. Anonymous,Eastern Stroke and Coronary Heart Disease Collaboration Research Croup. Blood pressure, cholesterol and stroke in eastern Asia[J]. Lancet, 1998;352(9 143): 1 801- 1 807.
29. Wang W. clinic trial of anti-hypertension, see Liu LS, chief editor: hypertension[M]. Beijing: The People Health Publishing Company. 1st edtion, 2001. p. 1 297- 1 325.
30. MacMahon S, Rodgers A, Neal B, Charmers J. Blood pressure lowering for the secondary United prevention of myocardial infarction and stroke[J]. Hypertension, 1997;29(2): 537-538.
31. Rodgers A, MacMahon S, Gamble G,Slattery J, Sandercock P, Warlow C. The United Kingdom Transient Ischaemic Attack Collaborative Group. Blood pressure and risk of stroke in patients with cerebrovascular disease[J]. BMJ, 1996;313(7 050): 147.
32. Wang W, Liu LS. The relation between blood pressure level and stroke recrudescence-1 520 vascular diseases patients were followed 4 years[J]. Chinese Journal of Hypertension, 2003;11(2): 106-108.
33. Wang W, Den Q, He H, Ma LY. Clinic evidence for treatment of underpressure to stroke secondary prevention[J]. Chinese J Evidence-Based Medicine, 2004;4(5): 355-358.
34. Specialist forum: facing health poverty.
35. Sroke: cure with rehabilitation training is most economical.
36. Liu M. Evidence-based medicine and clinic practice[J]. Chinese J Evidence-Based Medicine, 2001;1(1): 8-9.
37. Li JG, Hou GC. Fall of medicine proportion and related economic analysis in my hostpital[J]. Chin J hosp Admin, 2003;19(2): 104-106.
38. Ma XM, Ying LP, Zhong J, Zhang D. The study on regrouping flow of common surgery disease and shortening average stay days[J]. Chin J hosp Admin, 1999;15(10): 603-604.
39. van Straten A, van der Meulen JH, van den Bos GA, Limburg M. Length of hospital stay and discharge delays in stroke patients[J]. Stroke, 1997;28(1): 137-140.
40. Evers S, Voss G, Nieman F, Ament A, Groot T, Lodder J, Boreas A, Blaauw G. Predicting the cost of hospital stay of stroke patients: the use of diagnosis of related groups[J]. Health Policy, 2002;61(1): 21-42.
41. Wang X, Guo XE, Xu YY, Pan F, Liu L. State of non-value-adding patient days and affected factors[J]. J Fourth Mil Med Univ, 2001;22(6): 557-559.
42. Wang J, Xu TH, Tang J , Qi AQ, Shi DW. Medical expense analysis in two kinds diseases inpatients[J]. Health Economic Research, 2002;(7): 21-22.
43. Ma XS. Analysis of stay days, medical expense and affected factors[J]. Hospital Administration Journal of Chinese People’s Liberation Army, 2002;9(1): 78-80.
44. Gao XF, Zeng Q, Duan Y. Analysis of factors affected on the cost of hospital stay for stroke inpatients by recursive structural model[J]. Chinese Journal of Health Statistics, 2003;20(6): 332-334.
45. Ma J, Bai H, Xiao FK. Feasibility analysis of applying DRGs to hospital reform[J]. Chinese Health Enterprise Management, 1991;7(10): 472-774.
46. Zhong JZ, Xiang YY, Wang QL. Discuss applying DRGs to medical assurance[J]. Chinese Health Economy, 2001;20(2): 49.
47. Xu H, Jiang XQ, Wang YC. Discuss the fit degree of applying "DRGs-PPS" to hospitals management reform in China[J]. Chinese Hospital Management, 1991;11(1): 59-63.

Chinese Journal of Evidence-Based Medicine

Analysis of Factors on Expense in 1969 Cases of Stroke Inpatients

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