6117例住院死亡病例构成帕累托图分析_周娟.pdf

中国病案2023 年第 24 卷第 2 期 72 影响的因素进入决策树模型进行分析，决策树模型最终纳入实施 PTCA、置入支架数量、住院天数和合并肺炎 4 个变量。该研究显示，实施冠状动脉介入治疗和在冠状动脉内置入支架会增加住院费用，且置入支架的数量越多，患者的住院费用越高，这与黄成秀等15研究一致。为减轻患者的经济负担，医生应当因病施医，非必须置入冠脉支架的患者不置入；只有必须置入冠脉支架的患者才置入；同时，在保证治疗效果的前提下，选择价低质优的耗材。住院天数是 AMI 患者住院费用的影响因素。住院天数既是时间指标18，又是反映医疗治疗的指 标19。住院天数的延长，导致床位费、药品费、治疗费等医疗服务费的增加，加大了医疗资源的消 耗16。因此，医院在保证医疗质量的前提下减少住院天数，在减少医保基金的同时，也减轻患者的个人负担15。合并肺炎也会导致 AMI 患者住院费用的增加，IyerS 等人20研究显示，住院期间有并发症的患者病情较复杂，间接增加患者的住院费用。该研究建立的 AMI 患者住院费用分组模型为相关部门找到费用控制关键点提供依据。参考文献 1 马丽媛,吴亚哲,陈伟伟.中国心血管病报告 2018要点介绍J.中华高血压杂志,2019,27(8):712-716.2 范青丹,罗素新,沈健,等.急性 ST 段抬高型心肌梗死患者住院费用影响因素分析J.现代医药卫生,2019,35(17):2620-2623.3 辛伟伟,李鑫,王兴宁,等.急性心肌梗死患者住院总费用的影响因素分析J.河南医学研究,2021,30(24):4445-4449.4 李晓东.ST 段抬高型心肌梗死患者住院费用构成及影响因素的分析J.中国病案,2020,21(2):63-67.5 Olsen MA,Tian F,Wallace AE,et al.Use of Quantile egression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory ProceduresJ.Ann Surg,2017,265(2):331-339.6 张雪玉,王莉,罗璇,等.基于面板分位数回归的老年糖尿病足患者治疗费用影响因素分析J.中国卫生统计,2019,36(6):893-895.7 张一,唐雪峰,柳春.基于分位数回归的 FDI 城市分布影响因素研究J.统计与信息论坛,2016,31(10):75-81.8 薛允莲.logistic 回归结合决策树技术在冠心病患者住院费用组合分析中的应用J.中国卫生统计,2015,32(6):988-989,992.9 王川,陈琳,宋振,等.DRGs 模式和决策树组合模型在血液病患者住院费用研究中的应用J.中国卫生统计,2020,37(1):70-72.10 中华人民共和国国家统计局.居民消费价格指数.2021-09-18.https:/ 贾海文,刘静静.西安市PM2.5浓度的影响因素分析J.能源与环保,2021,43(8):75-80.12 蔡宏宇,吴荆,马苗苗,等.基于分位数回归的湖南省城市生态环境风险测度研究J.中阿科技论坛(中英文),2021,27(5):23-25.13 陈丽红,王露岚.某高校附属医院腹腔镜胆囊切除术病种费用及影响因素分析J.中国卫生统计,2021,38(2):300-302.14 张伟文,贺湘焱,李奇凤,等.分位数回归模型在新疆涂阳肺结核报告率生态学影响因素的应用分析J.现代预防医学,2019,46(3):385-388,393.15 黄秀芹,张传猛,孔旭辉,等.基于结构方程模型的急性心肌梗死患者住院费用影响因素研究J.西南军医,2019,21(6):586-589.16 黄广成,张远妮,邓光璞,等.急性心肌梗死患者住院费用的影响因素研究J.中国卫生统计,2021,38(1):124-127.17 Unto Hkkinen,PietroChiarello,Francesc Cots,et al.Patient classification and hospital costs of care for acute myocardial infarction in nine european countriesJ.Health Econ,2012,21(Suppl.2):19-29.18 宁传英,韩传恩.急性心肌梗死患者住院费用构成及影响因素通径分析 J.河南医学研究,2020,29(13):2340-2343.19 Surkan MJ,Gibson W.Interventions to Mobilize Elderly Patients andeduce Length of Hospital StayJ.Can J Cardiol,2018,34(7):881-888.20 Iyer S,Ciuryla V,Wang P.Impact of ventricular arrhythmias on hospitalization costs in patients with acute myocardial infarctionJ.Value In Health,2006,9(6):A350-A350.(2021-12-22 收稿)6117 例住院死亡病例构成帕累托图分析 周 娟 朱海静 程 菲 赵广利 马英豪 卢俊英 贾佃丽 王 磊*摘要 目的 对某院 6117 例住院死亡病例构成进行帕累托图分析，探讨死因疾病谱构成特点，为医院管理层提供参考依据。方法 按照国际疾病分类标准(ICD-10)对死因病种进行分类统计，利用 EXCEL 绘制某院 2008 年 1 月 1 日-2018 年 12 月 31 日 6117 例住院病例死因的帕累托图；利用 SPSS 16.0 进行数据统计分析。结果 2008 年 1 月 1 日-2018 年 12 月 31 日总病死率为 2.44%，死亡患者年龄多集中在 60 岁以上；其中男性为 2.59%，女性为 2.27%，男性显著高于女性，男性与女性住院患者病死率性别差异有统计学意义(2=27.51,P0.05)；死因顺位前 3 位为肿瘤(占比 43.89%)、呼吸系统疾病(占比 19.11%)和循环系统疾病(占比 18.80%)。通过帕累托图分析显示住院患者死因疾病谱主要因素为肿瘤和呼吸系统疾病，累计构成比为 63%。结论 通过帕累托图分析显示住院患者死因疾病谱前 3 位是肿瘤、呼吸系统疾病和循环系统疾病，男性患者病死率高于女性患者。60 岁及以上患者是死亡的重点人群。1 关键词 住院患者；死亡病例；帕累托图；死因疾病谱 中国人民解放军火箭军特色医学中心质量管理科，北京，100088 解放军总医院第四医学中心骨科医学部康复医学科，北京，100048*通信作者 中国病案2023 年第 24 卷第 2 期 73 Pareto Chart Analysis of 6117 Hospitalized Death Cases in a Hospital Pareto Chart Analysis of 6117 Hospitalized Death Cases in a Hospital Zhou Juan,Zhu Haijing,Cheng Fei,Zhao Guangli,Ma Yinghao,Lu Junying,Jia Dianli,Wang Lei*Abstract Abstract Objectives Objectives The Pareto Diagram of 6117 inpatient deaths in a hospital was analyzed to explore the characteristics of the composition of the cause of death disease spectrum,so as to provide reference for the hospital management.Methods Methods The causes of death were classified and counted according to the international classification of diseases(ICD-10),the Pareto Diagram of the causes of death of 6117 hospitalized cases in a hospital from January 1st,2008 to December 31st,2018 was drawn by Excel;SPSS 16.0 was used for data statistical analysis,and P0.05 showed that the difference was statistically significant.ResultsResults The total fatality rate was 2.44%in a hospital from January 1st,2008 to December 31st,2018.Male was significantly higher than female(2.59%male and 2.27%female).There was statistically significant difference between male and female inpatient mortality(2=27.51,P0.05).Most of the patients who died were over 60 years old.The top three causes of death were tumor(43.89%),respiratory diseases(19.11%)and circulatory diseases(18.80%).Pareto Chart analysis showed that the main causes of death spectrum of inpatients were tumor and respiratory diseases,and the cumulative component ratio was 63%.ConclusionsConclusions Pareto Diagram Analysis showed that the top three causes of death of hospitalized patients were tumors,respiratory diseases and circulatory diseases.The mortality of male patients was higher than that of female patients.Patients aged 60 and over were the key population of death.Key wordsKey words Hospitalized patients；Death case；Pareto Chart；Spectrum of causes of death FirstFirst-authorauthors addresss address PLA Rocket Force Characteristic Medical Center Quality Management Section,Beijing,100088,China Corresponding author Corresponding author Wang Lei 随着社会经济的飞速发展和居民生活习惯的改变，我国居民疾病谱