异基因造血干细胞移植患者医院感染的经济负担及DRG付费方式的调节作用OA
Economic burden of healthcare-associated infection in patients undergoing allogeneic hematopoietic stem cell transplantation and moderating effect of DRG payment methods
目的 评估异基因造血干细胞移植(allo-HSCT)患者医院感染现状及经济负担,探究疾病诊断相关分组(DRG)在医院感染与住院费用之间的调节作用.方法 回顾性研究2024年苏州大学附属第一医院接受allo-HSCT的患者,采用倾向性评分匹配(PSM)平衡医院感染组(感染组)与非医院感染组(对照组)的混杂因素,比较两组患者的住院日数及住院费用差异.采用广义线性模型分析医院感染、DRG付费方式及其交互项对住院费用的影响.结果 共纳入587例患者,医院感染发病率为24.02%.匹配后纳入139对患者.感染组患者的平均住院总费用为28.21万元,高于对照组的25.63万元(P<0.001),其中药品费用差异最大,为1.76万元.感染部位以血液为主;腹部和消化道感染所致经济负担最重(平均住院总费用为29.49万元).DRG付费组与非DRG付费组患者在住院日数、年龄等方面达到组间均衡(均P>0.05).调节效应分析显示,DRG付费与医院感染存在显著交互作用(β=-0.165,P=0.007),表明DRG能显著降低医院感染对住院费用的影响.在非 DRG付费组中,医院感染导致住院费用增加24.0%;而在DRG付费组中,费用仅增加5.1%.结论 allo-HSCT患者医院感染发病率高,所致经济负担重.DRG付费方式能有效削弱医院感染导致的费用增长.
Objective To assess the current status and economic burden of healthcare-associated infection(HAI)in patients undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to explore the modera-ting role of diagnosis-related group(DRG)in HAI and hospitalization expense.Methods A retrospective study was conducted on patients who received allo-HSCT at the First Affiliated Hospital of Soochow University in 2024.Pro-pensity score matching was used to balance the confounding factors of HAI group(infection group)and non-HAI group(control group),and differences in length of hospital stay and hospitalization expense were compared between the two groups.A generalized linear model was used to analyze the impact of HAI,DRG payment methods and their interaction terms on hospitalization expense.Results A total of 587 patients were included in the analysis,and the incidence rate of HAI was 24.02%.After matching,139 pairs of patients were included.The average total hos-pitalization expense of patients in infection group was 282 100 Yuan,which was higher than the 256 300 Yuan for the control group(P<0.001),with the largest difference in drug expense at 17 600 Yuan.The main infection site was bloodstream.The economic burden caused by abdominal and digestive tract infection was the heaviest(with an average total hospitalization expense of 294 900 Yuan).Patients in DRG and non-DRG payment groups were balanced between groups in terms of length of hospital stay,age,etc.(all P>0.05).The moderating effect analy-sis revealed a significant interaction between DRG payment and HAI(β=-0.165,P=0.007),indicating that DRG could significantly reduce the impact of HAI on hospitalization expense.In non-DRG payment group,HAI resulted in a 24.0%increase in hospitalization expense;while in DRG payment group,the expense only increased by 5.1%.Conclusion The incidence of HAI in patients undergoing allo-HSCT is high,and the economic burden is heavy.The DRG payment method can effectively reduce the expense increase caused by HAI.
王莹;金美娟;丁蔚;沈耀耀;伍志鹏;朱艳霞
苏州大学附属第一医院 感染管理处,江苏 苏州 215006苏州大学附属第一医院 感染管理处,江苏 苏州 215006苏州大学附属第一医院 感染管理处,江苏 苏州 215006苏州大学附属第一医院 血液科,江苏 苏州 215006苏州大学附属第一医院 医保办公室,江苏 苏州 215006苏州大学附属第一医院 教育培训处,江苏 苏州 215006
医药卫生
医院感染经济负担疾病诊断相关分组调节效应异基因造血干细胞移植
healthcare-associated infectioneconomic burdendiagnosis-related groupmoderating effectalloge-neic hematopoietic stem cell transplantation
《中国感染控制杂志》 2026 (6)
801-809,9
国家自然科学基金面上项目(72574107)江苏省医院协会医院管理创新研究重点基金资助项目(JSYGY-2-2024-249)江苏省医院协会医院管理创新研究基金资助项目(JSYGY-3-2023-111)
评论