ICU脓毒症护理成本构成影响因素及RBRVS、TDABC在成本核算中的应用研究

马英芝; 李玲; 刘海凤; 侯铭; 肖江琴; 郭峻氚; 李洁

doi:10.16766/j.cnki.issn.1674-4152.004023

ICU脓毒症护理成本构成影响因素及RBRVS、TDABC在成本核算中的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.004023

马英芝¹,
李玲²,
刘海凤³,
侯铭⁴,
肖江琴^4, ,,
郭峻氚²,
李洁²

1.
新疆医科大学护理学院，新疆乌鲁木齐 830001
2.
新疆维吾尔自治区人民医院重症医学科，新疆乌鲁木齐 830000
3.
新疆维吾尔自治区人民医院放疗科
4.
新疆维吾尔自治区人民医院护理部

基金项目:

新疆维吾尔自治区自然科学基金资助项目 2021D01C156

新疆维吾尔自治区人民医院院内项目 20220245

详细信息

通讯作者:
肖江琴, E-mail：xjqq320@163.com

中图分类号: R631 R47
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- 文章访问数: 7
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-08
- 网络出版日期: 2025-08-14

Analysis of nursing cost composition and application of RBRVS and TDABC in ICU sepsis

1.
College of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830001, China

摘要

摘要: 目的随着医疗技术的进步，脓毒症相关的护理需求也在不断增加，同时护理成本也在不断攀升。为有效降低护理的总开支，提高医疗服务效率和质量，本研究旨在探究ICU脓毒症护理成本构成影响因素及成本相对值法(RBRVS)和时间驱动作业成本法(TDABC)在成本核算中的应用效果。方法调取2023年1—6月新疆维吾尔自治区人民医院病案室218例脓毒症患者的临床资料。根据相关资料明确护理服务项目内容、记录操作频次，使用RBRVS和TDABC对脓毒症相关的护理成本进行核算。计算脓毒症护理服务项目总成本构成比，对比总成本与实际收费差异，计算回收比例。使用多元线性回归分析影响护理成本的主要因素。结果护理成本构成中人力成本占73.10%，材料成本占13.29%，间接成本占13.61%。结果得出脓毒症单病种护理服务项目平均总成本为72 861.174元，实际收费为21 181元，回收比例为29.07%。不同年龄、ICU入住时间、机械通气方式、是否合并压力性损伤患者的护理成本差异有统计学意义(P＜0.05)。多元线性回归分析显示，年龄、ICU入住时间、机械通气方式、合并压力性损伤、护理人员成本意识均是护理成本的影响因素(P＜0.05)。结论脓毒症护理服务项目成本受患者年龄、ICU入住时间、机械通气方式、合并压力性损伤、护理人员成本意识等因素影响。使用RBRVS和TDABC法能有效简化相关成本的核算，并反映出实际收费远远低于核算结果。定价机构需参照成本核算来设定合理的收费标准，加强人力、材料成本分配及间接成本的管控。
- 脓毒症 /
- 护理服务 /
- 成本核算 /
- 成本管理
Abstract: Objective With advancements in medical technology, the demands for sepsis-related nursing and nursing cost are increasing. In order to effectively reduce the total cost of nursing and improve the efficiency and quality of medical services, it is necessary to explore factors influencing nursing cost composition and to evaluate the application of the resource-based relative value scale (RBRVS) and time-driven activity-based costing (TDABC) models in the care of ICU patients with sepsis. Methods The clinical data from 218 patients with sepsis admitted to the People's Hospital of Xinjiang Uygur Autonomous Region between January and June 2023 were retrospectively analyzed. According to relevant data, content of nursing services and operating frequency were recorded. The costs of sepsis-related nursing were calculated by RBRVS and TDABC. The composition ratios of total nursing costs were calculated, and the differences between total costs and actual charges were analyzed to assess the cost recovery rate. The main factors influencing nursing costs were analyzed by multiple linear regression analysis. Results In terms of different nursing cots, proportions of labor, material, and indirect costs were 73.10%, 13.29%, and 13.61%, respectively. The average total cost of sepsis-related nursing services was 72 861.174 yuan, while the actual charge was 21 181 yuan, resulting in a cost recovery rate of 29.07%. Significant differences in nursing costs were observed across groups based on age, ICU stay duration, mechanical ventilation modes, and presence of pressure injuries (P < 0.05). Multiple linear regression analysis identified age, ICU stay duration, mechanical ventilation mode, pressure injuries, and cost-awareness among nursing staff as factors influencing nursing cost (P < 0.05). Conclusion The factors influencing the cost of sepsis nursing services include patients age, ICU stay duration, mechanical ventilation modes, presence of pressure injuries, and cost-awareness among nursing staffs. RBRVS and TDABC can effectively facilitate the accounting of related costs, reflecting that actual charge is much lower than the accounting results. Pricing institutions should establish reasonable charging standards based on cost accounting and enhance the management of labor, material, and indirect cost allocations.
- Sepsis /
- Nursing service /
- Cost accounting /
- Cost management

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图 1 脓毒症护理服务项目框架

Figure 1. Project framework of sepsis nursing services

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图 2 脓毒症护理服务项目总成本构成比

Figure 2. Total cost composition ratio of sepsis nursing services

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表 1 脓毒症相关护理服务单项目人力成本核算公式

Table 1. Accounting formulas of labor cost for each sepsis-related nursing service

项目	公式	备注
①相对价值比率(RVU)	①=Ci/Co	Ci为待测项目累加值，Co为参照项目累加值为2023年全年的服务总费用、护理工作总量
②货币转换系数(CF)	②=服务总费用/护理工作总量	Ci为待测项目累加值，Co为参照项目累加值为2023年全年的服务总费用、护理工作总量
③护理项目平均操作时间	③=16人次操作护理服务项目的总时间/16	随机选取16名护理人员开展临床护理工作
④单项目护理人力成本	④=①×②×③

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表 2 脓毒症相关护理服务单项目材料成本核算公式

Table 2. Accounting formulas of material cost for each sepsis-related nursing service

项目	公式	备注
①一次性耗材	①=耗材含税单价×实际消耗量	一次性耗材的使用严格遵守相关规范操作
②设备折旧费	②=设备当月折旧费/当月使用时间×使用次数	依照设备折旧的方式归集于材料成本
③材料成本	③=①+②

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表 3 不同项目脓毒症患者护理成本比较

Table 3. Comparison of nursing costs for patients with sepsis in different projects

项目	例数(%)	护理成本(x±s，元)	统计量	P值
性别			0.326^a	0.745
男性	121(55.50)	335.22±50.19
女性	97(44.50)	332.98±50.86
感染部位			0.700^b	0.498
肺部感染	104(47.71)	336.17±47.84
腹腔感染	67(30.73)	336.61±54.75
泌尿感染	47(21.56)	326.52±49.74
年龄(岁)			208.405^b	＜0.001
18~35	26(11.93)	252.10±21.39
36~60	44(20.18)	291.68±11.44
＞60	148(67.89)	361.30±34.05
ICU入住时间(d)			19.950^a	＜0.001
＜15 d	122(55.96)	298.30±31.69
≥15 d	96(44.04)	379.88±27.63
机械通气方式			6.904^a	＜0.001
无创通气	134(61.47)	317.30±49.97
有创通气	84(38.53)	361.22±37.91
合并恶性肿瘤			1.784^a	0.076
否	167(76.61)	330.88±52.94
是	51(23.39)	345.18±39.22
合并压力性损伤			10.007^a	＜0.001
否	172(78.90)	319.59±40.55
是	46(21.10)	388.93±45.99
护理人员工作年限			0.636^a	0.525
≥5年	97(44.50)	335.54±40.87
＜5年	121(55.50)	331.12±57.80
护理人员职称			0.884^a	0.378
中级	87(39.91)	337.91±65.14
高级	131(60.09)	331.78±37.04
护理人员成本意识			3.045^a	0.003
≥45分	151(69.27)	340.98±42.45
＜45分	67(30.73)	318.99±61.86
注：^a为t值，^b为F值。

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表 4 影响护理成本的多元线性回归分析

Table 4. Multiple linear regression analysis affecting nursing costs

项目	B	SE	β	t值	P值
年龄	37.387	1.970	0.518	18.977	＜0.001
ICU入住时间	44.953	3.498	0.444	12.850	＜0.001
机械通气方式	-8.429	2.941	-0.082	-2.866	0.005
合并压力性损伤	33.283	3.109	0.270	10.705	＜0.001
护理人员成本意识	35.417	3.201	0.364	11.472	＜0.001

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