基于DRG的心脏PCI术分组效果及费用影响因素分析  

Analysis of Factors Influencing the Grouping Effect and Cost of Cardiac PCI based on DRG

作　　者：马冀 张欣[1] 卢欣阳 罗蓟[1] Ma ji;Zhang Xin;Lu Xinyang;Luo Ji(Medical Insurance Department of the First Affiliated Hospital of China Medical University,Shenyang110000,Liaoning Province,China)

机构地区：[1]中国医科大学附属第一医院医疗保险工作部,辽宁省沈阳市110000

出　　处：《中国病案》2021年第6期47-51,共5页Chinese Medical Record

摘　　要：目的对冠状动脉支架置入患者DRG分组效果进行分析,找出影响住院费用的因素,为完善DRG分组规则及临床诊疗、管理提供参考依据.方法收集某三级甲等医院2019年2月1日-2020年7月31日行PCI手术共计1604例的住院病案首页信息及结算费用明细进行分析,运用Mann-Whitney U检验、单因素方差分析、多元线性回归等方式对分组效果及影响住院费用的因素进行分析.结果FM11组分别与FM13、FM15组比较差异具有统计学意义,P<0.001;FM13组与FM15组比较差异无统计学差异,P>0.05;冠状动脉支架置入术费用占总费用前三的收费类别分别为材料费占60%、手术治疗费占14%、药品费占10%.使用单个支架人均费用为46230.37元;使用2个及以上支架人均费用为72283.26元.冠状动脉支架置入病例总费用的首要影响因素为支架置入的数量,P<0.001,其次分别为是否合并其他操作,P<0.001;进行支架置入术次数,P<0.001;住院天数,P<0.001;是否合并心肌梗死,P<0.05.结论PCI术中的支架置入个数、一次住院行PCI的的次数、同时进行其他操作等是影响患者住院费用的主要因素,规范的医疗行为和医用耗材降费是控费的重要手段.Objective To analyze the grouping effect of DRG for patients with coronary stent implantation,find out the factors affecting the hospitalization expenses,and provide reference for the higher authorities to formulate the reasonable payment standards and the grouping basis.Methods By collecting the information on the first page of medical records and the details of settlement expenses,the total of 1604 patients who underwent PCI surgery in a large grade 3 A hospital from February 1,2019 to July 31,2020 were analyzed.Mann-whitney U test,one-way ANOVA,multiple linear regression and other methods were used to analyze the grouping effect and the factors affecting the hospitalization expenses.Results There were statistically significant differences between FM11 group and FM13 group and FM15 group respectively(P<0.001).There was no statistical difference between the FM13 group and the FM15 group(P=0.133);In terms of the cost of coronary stenting,materials(60%),surgical treatment(14%)and pharmaceutical products(10%)account for the top three fees.The per capita cost of using a single stent was 46230.37 yuan.The per capita cost of using two or more brackets was 72,283.26 yuan.The primary influencing factor of total cost of coronary stent implantation was the number of stent implantation(P<0.001),followed by whether other operations were combined(P<0.001),the number of times of stent implantation(P<0.001),the length of hospital stay(P<0.001),and whether myocardial infarction was combined(P<0.05).Conclusion The number of stents implanted in PCI,the number of times of PCI in one hospitalization and other operations are the main factors that affect the hospitalization expenses of patients.Standardized medical behavior and price reduction of medical consumables are important means to control the cost.

关 键 词：PCI DRG 住院费用 分组效果 影响因素 

分 类 号：R197.3[医药卫生—卫生事业管理]