CAJ | 학술논문

目的探讨多学科协作组模式对肺癌患者平均住院日及平均住院费用的影响.方法收集201 1年12月至2013年12月新诊断的肺癌病例,经肺癌多学科协作组讨论后,符合纳入及排除标准的病例97例(肺癌组),对照组为未经肺癌多学科协作组讨论的病例97例.统计两组的住院费用、住院日、肺癌分期及分型、Zubrod-ECOG-WHO评分(ZPS)、费用支付形式、吸烟史、性别、年龄等,并采用x2检验、t检验、多元线性逐步回归分析等统计学方法对两组平均住院费用及平均住院日及其影响因素进行分析.结果肺癌组97例,男68例,女29例,平均年龄(61 ±9)岁;对照组97例,男73例,女24例,平均年龄(63 ± 10)岁.两组分期、分型、ZPS评分、费用支付形式、吸烟史、性别及年龄等比较差异均无统计学意义(x2值为0.108 ～4.854,均P＞0.05).肺癌组和对照组的平均住院费用(13 303和16 553元)和平均住院日(10.33和12.49 d)比较,差异有统计学意义(t值为2.616和2.730,均P＜0.01);两组平均首诊住院费用(15 953和19 485元)、平均首诊住院日(12.71和14.75 d)比较,差异有统计学意义(t值为2.315和1.979,均P＜0.05).影响患者平均住院费用的主要因素为平均住院日和肺癌分期.除小细胞肺癌局限期患者外,肺癌组不同分期的患者无论平均住院费用还是平均住院日均比对照组低.肺癌组Ⅰ a～Ⅲa期和Ⅲb～Ⅳ期患者的住院费用和住院日(6 722元和1.09 d)低于对照组(8 188元和2.65 d).结论多学科协作组模式可降低肺癌患者的平均住院费用且平均住院日缩短,其平均首诊住院费用及平均首诊住院日均显著减少.多学科协作组模式可减少Ⅰ a～Ⅲa期和Ⅲb～Ⅳ期患者的住院费用和住院时间,其中Ⅰ a～Ⅲa期患者获益更多.
목적 탐토다학과협작조모식대폐암환자평균주원일급평균주원비용적영향.방법 수집201 1년12월지2013년12월신진단적폐암병례,경폐암다학과협작조토론후,부합납입급배제표준적병례97례(폐암조),대조조위미경폐암다학과협작조토론적병례97례.통계량조적주원비용、주원일、폐암분기급분형、Zubrod-ECOG-WHO평분(ZPS)、비용지부형식、흡연사、성별、년령등,병채용x2검험、t검험、다원선성축보회귀분석등통계학방법대량조평균주원비용급평균주원일급기영향인소진행분석.결과 폐암조97례,남68례,녀29례,평균년령(61 ±9)세;대조조97례,남73례,녀24례,평균년령(63 ± 10)세.량조분기、분형、ZPS평분、비용지부형식、흡연사、성별급년령등비교차이균무통계학의의(x2치위0.108 ～4.854,균P＞0.05).폐암조화대조조적평균주원비용(13 303화16 553원)화평균주원일(10.33화12.49 d)비교,차이유통계학의의(t치위2.616화2.730,균P＜0.01);량조평균수진주원비용(15 953화19 485원)、평균수진주원일(12.71화14.75 d)비교,차이유통계학의의(t치위2.315화1.979,균P＜0.05).영향환자평균주원비용적주요인소위평균주원일화폐암분기.제소세포폐암국한기환자외,폐암조불동분기적환자무론평균주원비용환시평균주원일균비대조조저.폐암조Ⅰ a～Ⅲa기화Ⅲb～Ⅳ기환자적주원비용화주원일(6 722원화1.09 d)저우대조조(8 188원화2.65 d).결론 다학과협작조모식가강저폐암환자적평균주원비용차평균주원일축단,기평균수진주원비용급평균수진주원일균현저감소.다학과협작조모식가감소Ⅰ a～Ⅲa기화Ⅲb～Ⅳ기환자적주원비용화주원시간,기중Ⅰ a～Ⅲa기환자획익경다.
Objective To explore the impacts of the multidisciplinary team model on the average length of stay and hospital expenses of patients with lung cancer.Methods After the multidisciplinary team discussion,97 patients with lung cancer were selected as the lung cancer group according to the enrollment and elimination criteria the control group was 97 patients with lung cancer managed without team discussion during the same period.All the patients were firstly diagnosed to have lung cancer from December 2011 to December 2013 in Subei People' s Hospital.The length of stay,hospital expenses,stages of tumor,types of tumor,Zubrod-ECOG-WHO score,the form of payment,smoking history,sex and age of all the patients were collected.The difference in the average length of stay and hospital expenses between the 2 groups and the associated factors were analyzed by using x2 test,t test and multi-factor stepwise regression analysis.Results There were 68 males and 29 females with a mean age of (61 ±9) years in the lung cancer group,while there were 73 males and 24 females with a mean age of (63 ± 10) years in the control group.There were no differences between the 2 groups in tumor staging,tumor types,Zubrod-ECOG-WHO score,the form of payment,smoking history,sex and age (x2 =4.854,P =0.563,x2 =4.248,P =0.097;x2 =0.395,P=0.821;x2=1.191,P=0.554;x2=0.108,P=0.977;x2=1.011,P=0.389;x2=0.649,P =0.519;P =0.474,P =0.845,respectively).The average hospital expenses(13 303 vs 16 553,Yuan) were lower and the length of stay (10.33 vs 12.49,days) was shorter in the lung cancer goup as compared to the control group (t =2.616,P =0.010;t =2.730,P =0.007),especially so for the first cliuical hospitalization(15 953 vs 19 485 yuan,t =2.315,P =0.022;12.71 vs 14.75 days,t =1.979,P =0.049).The average length of stay and the tumor stages were the main factors associated with the average hospital expenses.Except for patients with the limited stage of small cell lung cancer,the average length of stay and hospital expenses showed a tendency to reduce in different stages of the lung cancer group.The hospital cost was lower and the length of stay shorter for patients with stages Ⅰ a-Ⅲ a and Ⅲ b-Ⅳ in the lung cancer group as compared to the control group (6 722 vs 8 188 yuan;1.09 vs 2.65 days).Conclusions The multidisciplinary team model was an effective measure to cut down the hospital expenses and shorten the length of stay of lung cancer patients,especially for the first hospitalization.Patients may benefit from the multidisciplinary team approach according to their stages.On the basis of reducing the hospital costs and the length of stay,it further reduced the gap of the length of stay and hospital expenses between patients with Ⅰ a-Ⅲ a and Ⅲ b-Ⅳ diseases,while patients with stage Ⅰ a-Ⅲ a disease seemed to benefit more.