基于疾病诊断相关分组的脑梗死患者住院费用标准与分组效果  

Hospitalization Cost Standards and Grouping Effects of Patients with Cerebral Infarction Based on Diagnosis-Related Grouping

作　　者：宁传英[1] NING Chuan-ying(Medical Record Department,the First People’s Hospital of Shangqiu,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院病案科,河南商丘476000

出　　处：《河南医学研究》2020年第34期6347-6351,共5页Henan Medical Research

基　　金：河南省医院协会2020年度医院经济管理研究课题(HNYYJG-2020-04A)。

摘　　要：目的分析脑梗死患者住院费用构成及影响因素,为本地区疾病诊断相关分组(DRGs)费用标准的制定提供参考。方法选取商丘市第一人民医院2019年1月至2020年5月主要诊断为脑梗死(ICD编码为I63)的神经内科出院患者,收集其住院病案首页数据及住院费用等资料。根据DRG分组结果将患者分为BR25组(BR25脑缺血性疾病,不伴合并症与伴随病)、BR23组(BR23脑缺血性疾病,伴合并症与伴随病)和BR21组(BR21脑缺血性疾病,伴重要合并症与伴随病)。BR25组1339例,BR23组2644例,BR21组393例。采用多因素logistic回归分析患者住院费用和各个DRG组住院费用的影响因素。采用变异系数(CV)评价DRG分组结果的组内一致性,采用方差减少量(RIV)分析DRG组的组间异质性。结果医疗付款方式、是否转科、住院时间、伴随病个数是住院费用的正向影响因素,年龄、住院次数、出院时间、入院途径是住院费用的负向影响因素(P<0.05)。3组之间的分组效果均较好,即组内变异小(CV≤0.8)、组间异质性高(RIV=0.87)。BR25组权重最大(1.25)、费用标准最高(12713.17元)。3组中药品费占比均最大。BR21组、BR23组、BR25组CV、权重、住院时间、住院费用比较,差异有统计学意义(P<0.05)。BR21组CV、权重大于BR23组和BR25组,BR21组住院时间长于BR23组和BR25组,BR21组住院费用高于BR23组和BR25组(P<0.017)。BR23组CV、权重大于BR25组,BR23组住院时间长于BR25组,BR23组住院费用高于BR25组(P<0.017)。结论DRGs权重可以综合反映不同DRG分组疾病的严重程度和资源消耗情况,权重越大,医疗资源消耗越高,诊疗难度越大,相应的费用标准应越大。不同DRG组的影响因素可作为费用控制的关键点,住院费用构成作为内部结构调整的依据。Objective To analyze the composition and influencing factors of hospitalization cost of patients with cerebral infarction,and provide reference for the formulation of Diagnosis Related Groups(DRG)cost standards in the region.Methods The patients discharged from the Department of Neurology of the First People’s Hospital of Shangqiu who were mainly diagnosed with cerebral infarction(ICD code I63)were selected,and the data on the first page of their hospitalization records and hospitalization cost were collected.According to DRG results,the patients were divided into BR25 group(BR25 cerebral ischemic disease,without complications and concomitant diseases),BR23 group(BR23 cerebral ischemic disease,with complications and concomitant diseases)and BR21 group(BR21 cerebral ischemic disease,with important complications and accompanying diseases).There were 1339 cases in BR25 group,2644 cases in BR23 group and 393 cases in BR21 group.Multivariate logistic regression analysis was used to analyze the influencing factors of hospitalization expenses of all patients and each subgroup.Coefficient of variation(CV)was used to evaluate the intra-group consistency of DRG grouping results.Variance reduction(RIV)was used to analyze the inter-group heterogeneity of DRG groups.Results Medical payment methods,whether to be transferred to hospital,the length of hospitalization,and the number of concomitant diseases were positive factors that affected the cost of hospitalization,while the age,the number of hospitalizations,the time of discharge and the way of admission were negative factors(P<0.05).The three DRG groups were all effective,with small variation in the intra-group(CV was equal or more than 0.8),and the heterogeneity among groups was high(RIV was 0.87).BR25 group had the largest weight(1.25)and the highest cost standard(12713.17 yuan).The proportions of drug expenses in the three groups were the largest.There were statistical differences in CV,weight,the time of hospitalization and cost of hospitalization among BR21 group,BR2

关 键 词：脑梗死 疾病诊断相关分组 精细化管理 住院费用 医疗资源消耗 

分 类 号：R197.3[医药卫生—卫生事业管理]