基于倾向评分法研究医院获得性肺炎对患者临床结局及医疗成本的影响

doi:10.3969/j.issn.1006-5253.2020.03.012

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摘要目的探讨医院获得性肺炎对住院患者临床结局及医疗成本的影响。方法回顾性收集2017年5月1 日至2018年6月7日间温州市人民医院出院患者的临床资料，并根据是否发生医院获得性肺炎将患者分为两组。使用倾向评分匹配法对患者进行1∶6匹配。比较匹配前后两组患者在病死率、住院时间以及住院费用方面的差异。结果在44937例患者中，确定了314例医院获得性肺炎病例。倾向评分匹配前，医院获得性肺炎患者的病死率为3.5%（11/314），非医院获得性肺炎患者的病死率为0.1%（56/44623）（OR∶28.9，，95%C∶15.0~55.7）。倾向评分匹配后，与匹配的非医院获得性肺炎患者相比，医院获得性肺炎患者的病死率更高（3.9% vs.1.2%;P=0.003），住院时间更长[（M=24，IQR=17）vs（M=8，IOR=9）天;P<0.001]，医疗费用较高[（M=33450.2，IQR=31 572.3）元 vs（M=11375.9，IQR=14230.9）元;P<0.001]。医院获得性肺炎与患者病死率增高（OR=3.2，95%CI∶1.5~6.8），住院时间延长（绝对差异=19.9，95%CI∶17.2~22.6）和医疗费用增加（绝对差异=30438.4，95%CI=26367.0~34509.7）显著相关。结论与非医院获得性肺炎患者相比，医院获得性患者的病死率更高，住院时间更长，医疗费用更高。

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	陈志辉
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关键词 ：医院获得性肺炎, 病死率, 成本及成本分析, 医院感染, 倾向性评分

Abstract：Objective To estimate the impact of hospital-acquired pneumonia (HAP)on patient clinieal outcomes andmedical cost. Methods Medical records of patients discharged from Wenzhou people's hospital between May 1,2017 and June 7，2018 were reviewed. Patients were divided into two groups according to whether with hospital-acquired pneumonia. We developed a HAP propensity model and matched cases with non-HAP by propensity score at a 1:6 ratio.The differences were comparedinhospital mortality, length of stay and medical cost before and after matching. Results Among 44937patients,314 HAP cases were identified. Before matching,the in-hospital mortality rates were 3.6% (15/415) for those with HAP and 0.1%(56/44623) for those without HAP (OR=28.9,95%CI:15.0-55.7). After matching,HAP patients had higher mortality( 3.9%vs1.2%；P=0.003)，longer length of stay[(M=24,IQR=17)vs(M=8，IOR=9)days;P<0.001],and higher medical cost[(M=33450.2,IQR=31572.3)vs(M=11375.9，IQR=14230.9)；P<0.001]compared with matched non-HAP. HAP was significantly associated with in-hospital mortality (OR=3.2，95%Cl:1.5～6.8),inecreased length of stay(absolute difference =19.9, 95% Cl:17.2～22.6) and higher medical cost (absolute difference=30438.4,95%CI:26367.0～34509.7).Conclusion Patients with HAP contribute to higher in hospital mortality,longer length of stay and higher medical costs compared with non-HAP patients.

Key words： hospital acquired pneumonia hospital mortality cost and cost analysis nosocomial infection propensity score

收稿日期: 2910-10-01

基金资助:温州市公益性科技计划项目（Y20170679）

通讯作者: 陈志辉，Email∶czhdemail@126.com

引用本文:

陈志辉，吴红梅，王晨红，徐子琴，高胜春，陈乐. 基于倾向评分法研究医院获得性肺炎对患者临床结局及医疗成本的影响[J]. 中国医院统计, 2020, 27(3): 236-241.
Chen Zhihui,Wu Hongmei,Wang Chenhong,Xu Ziqin,Gao Shengchun, Chen Le. Impact of non-ventilated hospital-acquired pneumonia on patient clinical outcomes and medical cost:a propensity score-matched analysis. journal1, 2020, 27(3): 236-241.

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