4 种类型医院感染直接经济损失的配比病例对照研究
4 种类型医院感染直接经济损失的配比病例对照研究周清德 褚德发 高秀华
摘要 目的 了解肺部感染、泌尿道感染、深部术后伤口感染和颅内感染4 种重要类型医院感染所造成的直接经济损失。方法 采用1:1 配比病例对照研究方法, 调查95 对患者的医疗费用, 计算医院感染的直接经济损失。结果 病例组的平均医疗费用为38 741元, 对照组为18 376元, 平均每例感染病人多支出医疗费用20 365元( P< 0. 000 1) 。医疗费用的增加以西药费为主, 占总增加费用的62. 07%; 其次是治疗费、输血费和化验费, 分别占总增加费用的10. 32%、7. 40%和5. 72%。医院感染的经济损失因科室不同而异, 肿瘤血液科最高, 平均每例增加34 944元。肺部感染、泌尿道感染、深部术后伤口感染和颅内感染患者的医疗费用平均每例分别增加31 940元、7 436元、1 7 332元和17 349元。95 例感染患者的平均住院天数为50. 57 d, 比对照组的25. 22 d 高出25. 53 d( P < 0. 000 1) 。结论 医院感染严重增加了医疗费用支出, 降低了病床周转率; 认真做好医院感染监控工作可获得巨大经济效益和社会效益。
关键词： 医院感染; 经济损失; 病例对照研究
恕我愚钝，我向来不擅长算这个经济账，所以对于此文中医院感染直接经济损失和医院感染病例平均费用增加的概念怎么也看不明白。
我主要糊涂的是：貌似从摘要和全文来看，从医院的角度来看，没看到医院感染带来的经济损失啊，相反却是医疗费用的增加。
我一直都以为医院感染带来的经济损失比方是：由于医院感染降低了床位周转率从而导致经济损失，由于病原菌的传播导致感控措施强化从而导致成本增加，诸如此类的等等。
还请楚管指点迷津{:1_17:} 拙凌 发表于 2012-7-31 22:28 static/image/common/back.gif
恕我愚钝，我向来不擅长算这个经济账，所以对于此文中医院感染直接经济损失和医院感染病例平均费用增加的概 ...
聪明的脑袋就是不一样。本文作者是替患者算帐，替政府算帐，而你是替医院算帐。按你的角度算帐，可以说服领导支持院感工作，是个不错的角度{:1_12:} 楚楚 发表于 2012-7-31 22:35 static/image/common/back.gif
聪明的脑袋就是不一样。本文作者是替患者算帐，替政府算帐，而你是替医院算帐。按你的角度算帐，可以说服 ...
我是胡乱瞎猜啊，因为真的不懂这个什么经济学。我的思路只能说我对患者缺乏人文关怀，更加没有从政府的大局观来看。不过政府应该是比较看重那个劳什子GDP（其实什么是GDP我也不懂，就是放在这里镀金点缀一下）。如果我的思路有点意思，期待有懂经济的高人来研究一下，我就等着循证依据来说服领导了，嘿嘿 同意拙凌版版的意见！替社会，病人算账？在目前的形势下（目前院感工作的主要矛盾和矛盾的主要方面还是在医务人员和患者之间，不要站在医院和医务人员的对立面！），普通医院的普通院感人是否太伟大了一点？？谁来替院感工作埋单和撑腰？不是医院吗？有谁见过政府对医院的院感工作投入半毛币？以我市为例，医疗废物2.4元/床.日，收费标准却为5角，其他根本不允许医院收费，谁出钱？相当于拿着医务人员冒着生命危险辛辛苦苦挣的钱，嘴里念叨的是政府、病人（是医院的职能部门，应从医院的思路作为工作的出发点）？我也不高兴哈！当然，像影响行政决策的大专家（如校长）就可以这样算帐，在政府面前算账！如果价格体系发生变化，有一天真正能够得到政府承担公共责任，病人的维权和院感意识增强，则需改变工作思路！呵呵，不太和谐，也没有人性，但却是目前的现实状况！应立足现在，展望未来！呵呵！{:1_14:} 野渡无人 发表于 2012-8-1 00:58 static/image/common/back.gif
同意拙凌版版的意见！替社会，病人算账？在目前的形势下（目前院感工作的主要矛盾和矛盾的主要方面还是在医 ...
的确医疗价格定位不合理制约了医院感染管理事业的发展。如果今后实行单病种限价，效果会好一些。应呼吁政府部位给医疗价格建立一个合理的价格体系。 楚楚老师，非常不好意思，回复稍微晚了些。
配对病例对照研究的样本量确定：
配对的病例对照研究，推荐采用Schlesselman公式。
P=RR/(1+RR)
可以近似认为，P约等于OR/(1+OR)。
研究所需要的对子数大概为多少呢：
M=m/(P0q1+P1q0)
这里的m代表的是非配对时对子数,及Schlesselman公式：很复杂，暂时不列出，大家有兴趣可以去流行病学书上去查阅一下。
P0和P1分别代表对照组和病例组中的某因素的暴露率：q1=1-q0;p1=1-P0。
这里的暴露因素如何确定：
本文比较复杂，有四个主要的观察指标：肺部感染、泌尿道感染、深部术后伤口感染和颅内感染
一类错误，取0.05.
1-B，取0.70。
——未完待续
拙凌 发表于 2012-7-31 22:28 static/image/common/back.gif
恕我愚钝，我向来不擅长算这个经济账，所以对于此文中医院感染直接经济损失和医院感染病例平均费用增加的概 ...
目前较多的省市实行了医保的单病种限费制度，在这种制度下发生医院感染后多花的费用就是医院的钱了。比如剖宫产以5000元为限，发生SSI 后多花费的费用由医院买单或部分买单。我省的较多地市实行了这种医保限费，去年在我院的感染简报上就写了一篇医保对感控的影响的文章，所以这种情况下“经济损失”更为直观了。 推荐EPIINFOR 软件计算样本量。
这个软件是美国CDC官方发布的免费软件，目前是7.0版本。http://wwwn.cdc.gov/epiinfo/这个是地址。
我贴出来方便阅读：
What is Epi Info™?Physicians, nurses, epidemiologists, and other public health workers lacking a background in information technology often have a need for simple tools that allow the rapid creation of data collection instruments and data analysis, visualization, and reporting using epidemiologic methods. Epi Info™, a suite of lightweight software tools, delivers core ad-hoc epidemiologic functionality without the complexity or expense of large, enterprise applications.
Epi Info™ is easily used in places with limited network connectivity or limited resources for commercial software and professional IT support. Epi Info™ is flexible, scalable, and free while enabling data collection, advanced statistical analyses, and geographic information system (GIS) mapping capability.
Since its initial release, Epi Info™ users have self-registered in over 181 countries covering all continents including Antarctica. Epi Info™ has been translated in more than 13 languages.
More than one million users are estimated.
EDUCATIONEpi Info™ is a key component in public health education at colleges, universities, and other schools of public health around the world.
COLLABORATIONEpi Info™ encourages collaboration between local, national, and international partners using Epi Info™ state and territorial epidemiologists; national centers, institutes, and government offices; and foreign ministries of health and United Nations World Health Organization constituents.
INNOVATIONEpi Info™ is dedicated to enabling the innovation and leadership required to improve public health through informatics.
How is Epi Info™ Used?Epi Info™ is used worldwide for the rapid assessment of disease outbreaks; for the development of small to mid-sized disease surveillance systems; as ad hoc components integrated with other large scale or enterprise-wide public health information systems; and in the continuous education of public health professionals learning the science of epidemiology, tools, and techniques.
[*]The MakeView module of Epi Info™ allows users to create questionnaires and data entry forms called Views in Epi Info™. With MakeView, users place questions and data entry fields on one or many pages of a View and tailor the data entry process with conditional skip patterns, data validation, and custom calculations programmed by the user using MakeView's Check Code.
[*]The Enter module of Epi Info™ automatically creates the database from the questionnaire in MakeView. Users enter data, modify existing data, or search for records. With Enter, the Views are displayed and users perform the data entry while the Check Code validates the data or performs any automatic calculations that were specified in MakeView.
[*]The Analysis module is used to read and analyze data entered with the Enter module or data imported from 24 different data formats. Epidemiologic statistics, tables, graphs, and maps are produced with simple commands such as READ, FREQ, LIST, TABLES, GRAPH, and MAP. As each command is run, it is saved to the program editor where it can be customized and saved, shared, and used in the future as data are revised.
[*]The Epi Report module is a user-friendly tool to create professional custom reports that include results from the Analysis output. Epi Report can combine Analysis output with data from Enter as well as other sources such as Access or SQL Server. Reports can be saved as HTML files for easy distribution or web publishing.
[*]The Epi Map module displays geographic maps with data from Epi Info. Epi Map is built around the Environmental Systems Research Institute (ESRI) MapObjects software. Epi Map displays shapefiles containing the geographic boundaries layered with data results from the Analysis module.
[*]
非常可惜的时，最强大的EPI MAP不能使用。{:1_11:} 因为我国暂时还没有地图制式提供。
What are the system requirements for Epi Info™ 7?Microsoft Windows XP or above.
Microsoft .NET Framework 3.5 or above.
Recommended - 1 GHz processor
Recommended - 256 MB RAM
Should I upgrade from Epi Info™ 3.5.3?
Users do not need to choose between Epi Info™ 7 and Epi Info™ 3.5.3 because the two versions can coexist on the same machine.Epi Info™ 7 provides new capabilities that are designed to make it easier for epidemiologists to rapidly create complex forms, collect large amounts of data, and quickly analyze data to gain situational awareness.However, it is also a brand new platform that is expected to grow over time.Training videos, sample databases, and form templates are currently being developed to help users make the most of the new capabilities in Epi Info™ 7.On the other hand, Epi Info™ 3.5.3 is currently being downloaded worldwide and is already providing value to public health today.If Epi Info™ 3.5.3 is currently meeting your needs then we encourage you to continue using it.Epi Info™ 3.5.3 and Epi Info™ 6.04d will continue to be available for download and CDC is committed to continue providing technical support for these versions.
有的人可能使用的是3.5.3版本。这里点出了新版本的新功能
What can Epi Info™ 7 do that Epi Info™ 3.5.3 cannot?
Epi Info™ 7 provides new capabilities that are designed to make it easier for epidemiologists to rapidly create complex forms, collect large amounts of data, and quickly analyze data to gain situational awareness.Specifically, users will now be able to:
Distribute, deploy, and use Epi Info™ 7 during emergencies without ever requiring elevated privileges on a machine.
Quickly create event-specific forms by dragging and dropping templates.
Create complex questionnaire templates in advance that can be distributed and rapidly customized during emergencies.
Use new "Check Code" logic on forms such as Geocode, ZScore, EpiWeek, Enable, Disable, and Highlight.
Create forms that have more than 255 fields.
Store data either on a SQL Server when a network infrastructure is available or on local MS Access-compatible files when disasters disrupt network connectivity.
Collect data concurrently in a multi-user environment.
Link records together to create exposure relationships.
Visualize data on case-based cluster maps, social network analysis graphs, and a powerful new Visual Dashboard.
Create surveillance systems that leverage Early Aberration Reporting System (EARS) algorithms.
Perform nutritional anthropometry using up to date CDC and WHO standards.
Receive updates when new features, templates, and fixes become available.
蓝鱼o_0 发表于 2012-8-1 20:13 static/image/common/back.gif
楚楚老师，非常不好意思，回复稍微晚了些。
配对病例对照研究的样本量确定：
配对的病例对照研究，推荐采 ...
这段时间忙于其他俗务，虽则很快就看到了你非常专业的解答，而我却一直没有时间仔细领悟，不过今天有时间领悟了，却因为基础实在太差，却很难领悟。根据你的解答，不知道我理解的对不对，确定样本量的关键因素就是“某因素的暴露率”。就这篇文献来讲，对照组和病例组的暴露率具体是指什么？{:1_10:}请予以指导！ 谢谢老师，下载学习了 很有深度且很有意义的讨论，虽然我不是非常懂{:1_7:}。但我觉得如果真的把这个院感发生与否所造成损失统计做好的话，应该是一篇不错的论文。可以发表！又或者能让国家对于感控工作给予一定的资金，我是想到哪说哪，没有什么科学依据，还请老师们见谅！ 很有意义也很实际的讨论。拜读了。
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