未经评估:急性后护理在中国发展迅速,然而,急性后护理的支付系统尚未建立。由于中风是中国死亡和残疾的主要原因,在所有住院患者中,患者占急性护理后患者的很大比例.这项研究旨在确定成本决定因素,并建立中国中风患者急性后护理系统的病例组合分类。
UNASSIGNED:选取金华市7家医院2018年1月至2020年12月5401例急性脑卒中后患者。人口特征,医疗状况,功能措施(例如,Barthel指数,迷你精神状态检查,狼吞虎咽的屏幕,汉密尔顿抑郁量表),并提取了成本数据。进行了广义线性模型(GLM)和分位数回归(QR)来确定成本的预测因子,并利用决策树分析建立了病例混合分类模型。
未经批准:GLM回归显示性别,气管造口术,并发症或合并症(CC),日常生活活动(ADL),认知障碍是影响急性脑卒中后患者住院费用的主要变量。QR模型显示性别,气管造口术和CC因子对上分位数的每日成本影响更大.相比之下,认知障碍对低分位数的影响更大,和ADL显著影响中心分位数。用气管造口术,CC,和ADL作为回归树的节点变量,产生了12个类。案例混合分类执行可靠和稳健,根据变异统计量(RIV=0.46)和特定类别变异系数(CV小于1.0;范围:0.18-0.81)的降低来衡量。
UNASSIGNED:QR在全面识别跨成本组的成本预测因素方面具有优势。气管造口术,CC,ADL和ADL可显著预测脑卒中患者急性后护理费用。建立的病例组合分类系统可以为中国未来的急性后护理支付政策提供信息。
UNASSIGNED: Post-acute care is fast developing in China, yet a payment system for post-acute care has not been established. As stroke is the leading cause of mortality and disability in China, patients constitute a large share of post-acute-care patients among all hospitalized patients. This study was to identify the cost determinants and establish a
case-mix classification of the post-acute care system for stroke patients in China.
UNASSIGNED: A total of 5401 post-acute stroke patients in seven hospitals of Jinhua City from January 2018 to December 2020 were selected. Demographic characteristics, medical status, functional measures (eg, the Barthel Index, Mini-Mental State Examination, Gugging Swallowing Screen, Hamilton Depression Scale), and cost data were extracted. Generalized linear model (GLM) and quantile regression (QR) were conducted to determine the predictors of cost, and a
case-mix classification model was established using the decision-tree analysis.
UNASSIGNED: The GLM regression revealed that gender, tracheostomy, complication or comorbidity (CC), activities of daily living (ADL), and cognitive impairment were the main variables significantly affecting the hospitalization expenses of post-acute stroke patients. The QR model showed that the gender, tracheostomy and CC factors had a more significant impact on per diem costs on the upper quantiles. In contrast, cognitive impairment had a more substantial effect on the lower quantiles, and ADL significantly impacted the central quantile. Using tracheostomy, CC, and ADL as node variables of the regression tree, 12 classes were generated. The
case-mix classification performed reliably and robustly, as measured by the reduction in the variation statistic (RIV=0.46) and class-specific coefficients of variation (CV less than 1.0; range: 0.18-0.81).
UNASSIGNED: QR has strengths in comprehensively identifying cost predictors across cost groups. Tracheostomy, CC, and ADL significantly can predict the expenses of post-acute care for stroke patients. The established
case-mix classification system can inform the future payment policy of post-acute care in China.