医改前后某医院外地住院患者DRGs的权重分析  

Weight Analysis of DRGs Group of Non-local Inpatients in a Hospital Before and After Medical Reform

作　　者：邓应梅[1] 董爱然[1] 张丽[1] 王颖[1] 杜晓曦[1] Deng Yingmei;Dong Airan;Zhang Li;Wang Ying;Du Xiaoxi(Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院

出　　处：《中国病案》2019年第11期44-47,共4页Chinese Medical Record

摘　　要：目的了解北京市医药分开综合改革前后外地患者住院比例和疑难危重疾病的构成变化。方法选取北京某三甲综合医院2016年4月-2018年3月期间来院外地患者住院的病案首页数据,通过北京地区住院医疗服务绩效评价平台采集住院患者的DRGs分组结果,采用Excel 2007和SPSS19.0进行2组数据的卡方分析和双因素方差分析。结果医改前后外地、本地患者进入有效DRGs的患者例数没有统计学差异(χ^2=0.418,P>0.05);而医改后低权重组的总权重和大于医改前的总权重和(F=370.354,P<0.01);医改后手术DRGs组的总权重和高于医改前(F=24.626,P<0.01);医改后高权重手术DRGs的总权重没有增加,而低权重手术DRGs组的总权重增加(F=434.19,P<0.01)。结论北京市医药分开综合改革后,某院收治外地患者的病种结构改变,外地疑难、危重手术患者的增多。医院应有针对性地开展疑难危重病的诊治以及三四级手术,引导外地患者大病住院,小病在户籍居住地的就医趋势,促使各地患者理性就医。Objective To investigate the change of the proportion of non-local patients in hospital and the composition of patients with difficult and serious diseases before and after the comprehensive reform of medicine separation in Beijing.Methods The front pages data of medical records of hospitalized patients from outside Beijing from April 2016 to March 2018 in a top three general general hospital in Beijing were selected.DRGs grouping results of inpatients were collected through the inpatient medical service performance evaluation platform in Beijing,and chi-square analysis and two-factor variance analysis of the two groups of data were conducted by Excel 2007 and SPSS19.0.Results Before and after medical reform,there was no difference in the number of non-local and local patients entering the effective DRGs group(2=0.418,P>0.05).The total weight sum of low-power restructuring after medical reform was greater than that before medical reform(F=370.354,P<0.01).The total weight of surgical DRG group after medical reform was higher than that before medical reform(F=24.626,P<0.01).After medical reform,the total weight of high-weight operation DRG group did not increase,while that of low-weight operation DRG group increased(F=434.19,P<0.01).Conclusions After the comprehensive reform of medicine in Beijing,the number of patients admitted to a hospital in other places increased.Hospitals should carry out targeted diagnosis and treatment of difficult critical diseases as well as tertiary and tertiary surgeries,guide the trend of hospitalization of non-local patients with serious diseases and minor diseases in their registered residence,and promote rational medical treatment of patients everywhere.

关 键 词：医药分开 综合改革 外地患者 住院患者 DRG分组 高权重DRG组 

分 类 号：R197.3[医药卫生—卫生事业管理]