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유방암환자의 진료기간 및 진료비 분석

Other Titles
 (The) analysis of length of care and charges for patients with breast cancer 
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역학 및 질병관리학과/석사

유방암 환자의 진료기간 및 진료비를 분석하고 이들에 영향을 미치는 요인을 구명하기 위하여 한 종합병원에서 1994년 10월부터 1995년까지 유방암 수술을 받은 환자 133명을 대상으로 조사를 실시하여 분석하였다.

유방암 환자의 총진료기간중 진료비 분포는 수술입원전 진료에서는 검사료, 수술입원중에는 수술료가 포함된 처치료의 구성비가 높았으며, 퇴원후 진료시에는 치료비용이 포함된 주사·약대료와 처치료가 높은 비중을 차지하였다.

중회귀분석을 통한 수술입원중 재원기간의 결정요인 분석에서 거주지,수술전재원일, 수술방법,TNM stage가 통계학적으로 유의한 영향을 미쳤다. 수술입원중 진료비에는 병실등급과 재원기간의 영향이 컸으며 입원중 치료 방법과 전과여부, 동반수술여부 등의 임상적 특성을 나타내는 변수들이 통계학적으로 유의하였다.

총진료기간중 총외래방문횟수에서는 거주지와 타병원 치료가 음의 관계를 보인 반면 퇴원후 치료방법은 양의 관계를 가지는 설명변수였다. 총재원기간에서는 수술전 재원일, 수술방법, 거주지 등 수술입원중의 재원기간에 영향을 미쳤던 변수에, 추가로 재입원 여부,

퇴원후 방사선 치료 등이 총재원기간에 영향을 미치는 변수였다. 총진료비에서는 총외래 방문횟수와 총재원기간이 가장 큰 영향을 미치는 변수였고 특실·일인실의 병실등급과 전과여부, 수술전 재원일이 통계학적으로 유의하였다.

유방암 환자의 진료기간 및 진료비는 여러 특성에 의하여 영향을 받으며 이들 특성중 수술전 재원일, 수술방법, 병실등급 등 병원에서 일부 조정 가능한 요인에 의한 영향이 컸다. 향후 유방암의 생존율이나 진료결과와 관련된 추가적인 변수의 선정이 필요하며 의사의 특성 및 병원의 특성을 나타내는 변수를 포함한 분석이 필요하다고 생각한다.


This study was conducted to determine the factors affecting the length of care and charges for patients with breast cancer. Medical records of 133 patients who had an operation between 1,October,1994 and 31,December,1995 were sampled for analysis of the length of care and charges

The results acquired were as follows:

1.The charges for their total period of care were examined.It was identified that examination fee for preoperative care period and procedure fee including operation charge for inpatient(or operative )care period took a large part of the charge. And during postoperative care period, it cost a great deal for in ction or medication fee.

2.Analysis of factors affecting the length of stay through multiple regression. Showed that residence, preoperative length of stay, method of operation and TNM stage were statistically significant. The charge of operational period was mostly influenced by level of the ward and length of hospital stay, inaddition, method of treatment, transfer and concurrent operations shich show clinical characteristics were statistically important variables.

3.From the analysis of the total number of OPD visit, residence and treatment at other hospital was negative and therapy after dischage was positive explanatory variables. Preoperative length of stay, method of operation and residence were most significant variables for total length of hospital stay, Re-admission and radiation therapy after discharge were alse selected as important factors affecting the total length of hospital stay. Total charges were significantly influenced by total number of OPD visit and total length of hospital stay. A VIP ward or private ward, transfer and preoperative length of stay were also statistically meaningful.

Length of care and charges for breast cancer patients undergo various influences. Out of all the factors affecting the length of care and charges, clinical factors like preoperative length of stay, method of operation,level of ward which were controllable by hospital had a large effect. It is recommended to identify additional variables associated with survival rate or operation result so as to undertake further empirical analysis in relation to variables, showing characteristics of doctors or hospital.
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