基于支付方式的急性心肌梗死不同治疗方案选择的经济学评价

项目名称： 基于支付方式的急性心肌梗死不同治疗方案选择的经济学评价

项目编号： No.71203141

项目类型： 青年科学基金项目

立项/批准年度： 2013

项目学科： 宏观管理与政策

项目作者： 李娜

作者单位： 上海交通大学

项目金额： 19万元

中文摘要： 新医改背景下，上海市实施了医保预付制支付方式改革。而急性心肌梗死（AMI）治疗方案的选择目前没有客观判断指标，其经济学评价在我国尚无相关报道。本研究旨基于医保支付方式改革，为AMI不同治疗方案的选择提供依据。采用回顾性队列研究方法1.选择上海交通大学附属瑞金医院2009-2012年的AMI病例2.采用调查表对其病史进行摘录，收集人口社会学资料、治疗方法、住院费用、出院转归。3.电话和入户随访，收集住院期间交通、误工费用和生存状况。4.采用SAS、Nvivo等软件进行定量和定性分析，探讨影响治疗费用和预后的因素。5.进而对不同治疗方案在支付方式改革前后的成本-效果、效益、效用进行比较分析，结合文献综述、专家访谈并利用结构方程模型和多层线性模型验证。基于研究成果、结合新医改时期的医保政策导向，选择符合患者病情的、经济有效的最佳治疗方案，从而降低住院费用、减轻患者疾病经济负担、有效利用卫生资源。

中文关键词： 急性心肌梗死；支付方式；住院费用；经济学评价；

英文摘要： Under the background of new medical reform, method of payment of pay in advance has been carried out since 2011 in Shanghai. It has not been a objective standard to choose treatment scheme about AMI (acute myocardial infarction) at present and no report about the economic evaluation in our country. The objective of this study was to supply the basis on the choice of treatment scheme under the different methods of payment. A retrospective cohort study will be conducted in ruijin hospital group in Shanghai, China. The first step is the retrospective study chose the patients with AMI the performed by thrombolytic therapy, PTCA and operation from 2008 to 2012.2.the second step is to using a questionnaire that collected baseline information on demography, treatment, hospitalization payment and discharge outcomes through excerpting medical record.3.the third step is to obtain the cost about traffic and loss of working time as well as survival condition using telephone follow-up.4.Then to explore the factors with the costs and prognosis using SAS and Nvivo softerware.4.And then this study will complete a comparative analysis of the patients′baseline, surgery and the situation after being treated before and after the reform including cost-effectiveness analysis ,cost-benefit analysis and cost-utility analysis. Structura

英文关键词： acute myocardial infarction；payment；hospital expenditure；economic evaluation；