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.	脑卒中发病位居全球第二, 发病呈南低北高之势[Z]. Available from: URL: http://www.haowawa.com/A4/2003-11-06/A40503200311061030200000.asp.
2.	戚少华. 老年脑卒中危险因素的研究[J]. 老年医学与保健, 2002;8(3): 140～143.
3.	张红叶, 杨军, 周北凡, 武阳丰, 李莹, 陶寿淇. 我国十组人群脑卒中危险因素的前瞻性研究[J]. 中国慢性病预防与控制, 1996;4(4): 150～152,172.
4.	王文. 抗高血压临床试验. 见刘力生, 主编. 高血压[M]. 第1版. 北京: 人民卫生出版社, 2001.p. 1 297～ 1 325.
5.	王文, 刘力生. 血压水平与脑卒中再发的关系--1 520例脑血管病患者随访4年[J]. 高血压杂志, 2003;11(2): 106～108.
6.	王文, 邓卿, 何华, 马丽媛. 降压治疗对脑卒中二级预防的临床证据[J]. 中国循证医学杂志, 2004;4(5): 355～358.
7.	专家论坛: 直面健康贫困[Z]. Available from: URL:http://www.lsinfo.gov.cn/shownews.asp?NewsID=6694(2003-08-19).
8.	脑卒中: 治疗+康复训练最经济[Z]. Available from: URL:http://www.chinaneurosurgery.net/nous/nxgb/nzzzl.htm.(2003-11-26).
9.	刘鸣. 循证医学与临床实践[J]. 中国循证医学杂志, 2001;1(1): 8～9.
10.	李继光, 侯桂春. 我院降低药品收费构成比及有关的医疗经济分析[J]. 中华医院管理杂志, 2003;19(2): 104～106.
11.	马谢民, 英立平, 钟军, 张丹. 常见手术病种住院流程重组与缩短平均住院日的研究[J]. 中华医院管理杂志, 1999;15(10): 603～604.
12.	王霞, 郭秀娥, 徐勇勇, 潘峰, 刘理. 住院患者无效住院日的存在状况及其影响因素[J]. 第四军医大学学报, 2001;22(6): 557～559.
13.	王玖, 徐天和, 唐军, 祁爱琴, 石德文. 两单病种住院病人不必要医疗费用分析[J]. 卫生经济研究, 2002;(7): 21～22.
14.	马旭升. 病种住院日和医疗费用分析及影响因素[J]. 解放军管理杂志, 2002;9(1): 78～80.
15.	高晓凤, 曾庆, 段云. 卒中病人住院费用影响因素的递归系统模型分析[J]. 中国卫生统计, 2003;20(6): 332～334.
16.	马娟, 白红, 肖福坤. DRGs在医院改革中应用的可行性分析[J]. 中国卫生事业管理, 1991;7(10): 472～474.
17.	钟洁珍, 向月应, 王庆林. 医疗保险中实施DRGs的探讨[J]. 中国卫生经济, 2001;20(2): 49.
18.	徐辉, 姜秀琴, 王彦昌. 论"DRGs-PPS"在我国医院管理改革中应用的适合度[J]. 中国医院管理, 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. 脑卒中(中风)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. 脑卒中发病位居全球第二, 发病呈南低北高之势[Z]. Available from: URL: http://www.haowawa.com/A4/2003-11-06/A40503200311061030200000.asp.
2. 戚少华. 老年脑卒中危险因素的研究[J]. 老年医学与保健, 2002;8(3): 140～143.
3. 张红叶, 杨军, 周北凡, 武阳丰, 李莹, 陶寿淇. 我国十组人群脑卒中危险因素的前瞻性研究[J]. 中国慢性病预防与控制, 1996;4(4): 150～152,172.
4. 王文. 抗高血压临床试验. 见刘力生, 主编. 高血压[M]. 第1版. 北京: 人民卫生出版社, 2001.p. 1 297～ 1 325.
5. 王文, 刘力生. 血压水平与脑卒中再发的关系--1 520例脑血管病患者随访4年[J]. 高血压杂志, 2003;11(2): 106～108.
6. 王文, 邓卿, 何华, 马丽媛. 降压治疗对脑卒中二级预防的临床证据[J]. 中国循证医学杂志, 2004;4(5): 355～358.
7. 专家论坛: 直面健康贫困[Z]. Available from: URL:http://www.lsinfo.gov.cn/shownews.asp?NewsID=6694(2003-08-19).
8. 脑卒中: 治疗+康复训练最经济[Z]. Available from: URL:http://www.chinaneurosurgery.net/nous/nxgb/nzzzl.htm.(2003-11-26).
9. 刘鸣. 循证医学与临床实践[J]. 中国循证医学杂志, 2001;1(1): 8～9.
10. 李继光, 侯桂春. 我院降低药品收费构成比及有关的医疗经济分析[J]. 中华医院管理杂志, 2003;19(2): 104～106.
11. 马谢民, 英立平, 钟军, 张丹. 常见手术病种住院流程重组与缩短平均住院日的研究[J]. 中华医院管理杂志, 1999;15(10): 603～604.
12. 王霞, 郭秀娥, 徐勇勇, 潘峰, 刘理. 住院患者无效住院日的存在状况及其影响因素[J]. 第四军医大学学报, 2001;22(6): 557～559.
13. 王玖, 徐天和, 唐军, 祁爱琴, 石德文. 两单病种住院病人不必要医疗费用分析[J]. 卫生经济研究, 2002;(7): 21～22.
14. 马旭升. 病种住院日和医疗费用分析及影响因素[J]. 解放军管理杂志, 2002;9(1): 78～80.
15. 高晓凤, 曾庆, 段云. 卒中病人住院费用影响因素的递归系统模型分析[J]. 中国卫生统计, 2003;20(6): 332～334.
16. 马娟, 白红, 肖福坤. DRGs在医院改革中应用的可行性分析[J]. 中国卫生事业管理, 1991;7(10): 472～474.
17. 钟洁珍, 向月应, 王庆林. 医疗保险中实施DRGs的探讨[J]. 中国卫生经济, 2001;20(2): 49.
18. 徐辉, 姜秀琴, 王彦昌. 论"DRGs-PPS"在我国医院管理改革中应用的适合度[J]. 中国医院管理, 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. 脑卒中(中风)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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