CAJ | 학술논문

目的：了解日间手术中心运行对住院医疗费用的影响。方法收集珠三角某三级甲等医院2013年10月至2013年12月在日间手术中心出院的473例手术患者的数据，并从中选择出院人数最多的前两位主要病种：乳腺良性肿瘤177例、腹股沟斜疝135例（两个病种占日间手术中心总出院人数66.6%）作为讨论对象，以同期非日间手术模式的乳腺良性肿瘤、腹股沟斜疝手术患者作为对照组，对两组手术患者的平均住院天数、平均住院总费用、平均药费等进行对比分析，了解日间手术中心运转模式实施前后平均住院天数、平均住院费用、平均药费的变化情况。并对两组数据进行正态性检验，符合正态分布的数据采用t检验，不符合正态分布的数据采用非参数检验（Mann-Whitney U 检验），比较两组之间的差异。结果日间手术模式患者的平均住院日缩短,两个病种的平均住院日均由原来的2天缩短为1天，差异具有统计学意义（乳腺良性肿瘤：Z=17.462，P＜0.001腹股沟斜疝：Z=10.79，P＜0.001）；乳腺良性肿瘤、腹股沟斜疝两个病种的人均总医疗费用分别下降9.7%（Z=8.558，P＜0.001）和9.4%( Z=2.143，P=0.032)，差别有统计学意义；乳腺良性肿瘤人均药费均下降73.1%（Z=10.672，P＜0.001）差别有统计学意义，腹股沟斜疝人均药费均2.2%（Z=0.402，P=0.688）差别无统计学意义，如果将两个病种的药费加起来再进行比较，则差异具有统计学意义（Z=6.611，P＜0.001）。结论日间手术模式能有效缩短患者住院时间、降低患者住院医疗费用，调整医院收入结构，是缓解“看病难、看病贵”的有效途径。
목적：료해일간수술중심운행대주원의료비용적영향。방법수집주삼각모삼급갑등의원2013년10월지2013년12월재일간수술중심출원적473례수술환자적수거，병종중선택출원인수최다적전량위주요병충：유선량성종류177례、복고구사산135례（량개병충점일간수술중심총출원인수66.6%）작위토론대상，이동기비일간수술모식적유선량성종류、복고구사산수술환자작위대조조，대량조수술환자적평균주원천수、평균주원총비용、평균약비등진행대비분석，료해일간수술중심운전모식실시전후평균주원천수、평균주원비용、평균약비적변화정황。병대량조수거진행정태성검험，부합정태분포적수거채용t검험，불부합정태분포적수거채용비삼수검험（Mann-Whitney U 검험），비교량조지간적차이。결과일간수술모식환자적평균주원일축단,량개병충적평균주원일균유원래적2천축단위1천，차이구유통계학의의（유선량성종류：Z=17.462，P＜0.001복고구사산：Z=10.79，P＜0.001）；유선량성종류、복고구사산량개병충적인균총의료비용분별하강9.7%（Z=8.558，P＜0.001）화9.4%( Z=2.143，P=0.032)，차별유통계학의의；유선량성종류인균약비균하강73.1%（Z=10.672，P＜0.001）차별유통계학의의，복고구사산인균약비균2.2%（Z=0.402，P=0.688）차별무통계학의의，여과장량개병충적약비가기래재진행비교，칙차이구유통계학의의（Z=6.611，P＜0.001）。결론일간수술모식능유효축단환자주원시간、강저환자주원의료비용，조정의원수입결구，시완해“간병난、간병귀”적유효도경。
Objective To understand the impact of the running of day surgery center to the medical expense of hospitalization patients.Methods To collect the data of 473 cases of operation patients discharged from the day surgery center of a hospital from October to December 2013 in a Three A and Tertiary Hospital in Pearl River Delta,and selected two kinds of main diseases with the most discharged patients as discuss objectives,177 cases of breast benign tumor and 135 cases of oblique inguinal hernia,which accounted for 66.6% of all the diseases,then took the operation cases of breast benign tumor and oblique inguinal hernia performed in the same period not discharged from day surgery center.To conduct comparative analysis on the items such as average hospitalization days,average hospitalization expenses and average drug cost,and compared the changes before and after the application of the mode of day surgery center.Then conducted normality test on the data in the two groups,t test was adopted on the data obey the normal distribution while others adopted Mann-WhitneyUtest,and compared the differences between the two groups.Results The average hospitalization days of patients in the day surgery mode was shorted,which had been decreased from two days before to one day of the two kinds of diseases,the difference had statistical significance(Mann-WhitneyU:Z=17.462,P<0.001,oblique inguinal hernia:Z=10.79,P<0.001). The average hospitalization expense of the two kinds of diseases were decreased 9.7%(Z=8.558,P<0.001) and 9.4%(Z=2.143,P=0.032),the difference had statistical significance.The average drug cost of breast benign tumor decreased 73.1%(Z=10.672,P<0.001),the difference had statistical significance,while that of oblique inguinal hernia decreased 2.2%(Z=0.402,P=0.688),the difference had no statistical significance.If we conduct comparison with the add up of the drug costs of the two diseases, the difference had statistical significance (Z=6.611,P<0.001).ConclusionsThe day surgery mode could shorten the hospitalization days and decrease the hospitalization expense of the patients,it is an effective way to alleviate the situation of "difficult and expensive visiting of doctors" by adjust the income structure of the hospital.