基于DRG核心指标的心血管内科运营  

DRG core indicators guided cardiovascular specialized⁃disease wards operation and health insurance cost control

作　　者：王子盾[1] 戴卉 陈加玉 丁海霞 彭澎 WANG Zidun;DAI Hui;CHEN Jiayu;DING Haixia;PENG Peng(Department of Cardiology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Medical Records and Statistics Room,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Medical Insurance Division,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏南京210029 [2]南京医科大学第一附属医院病案统计科,江苏南京210029 [3]南京医科大学第一附属医院医疗保险处,江苏南京210029

出　　处：《南京医科大学学报（社会科学版）》2022年第6期609-614,共6页Journal of Nanjing Medical University（Social Sciences）

基　　金：江苏高校优势学科建设工程三期项目立项学科(苏政办发〔2018〕87号)。

摘　　要：回顾性收集2019—2021年南京一所大型三级甲等教学医院心血管内科运营数据,从病案统计科年度统计数据中提取疾病诊断相关分组(diagnosis related groups,DRG)核心指标,从医疗保险处年度统计数据中提取医保消耗额度,进而对比其中三个同规模病区(两个特色专病病区和一个综合病区)的数据。结果显示,心血管内科不同亚专业专病病区的运营各有特色。电生理专病病区手术难度高,成本消耗大;冠心病专病病区患者周转快,成本消耗低。与综合病区相比,专病病区的收治病种类型集中,且需手术操作的患者较多。专病病区经合理管控后,医保费用节约更多。通过建设心血管内科亚专业专病病区,可以促进临床诊疗路径化,缩短介入操作的学习曲线,更易于成本管控、学科发展和人才培养。This study retrospectively collected operational data of three typical specialized⁃disease wards from records of the cardiovascular department from a tertiary hospital in Nanjing from 2019 to 2021.In order to compare the differences between the two specialized⁃disease wards and one ordinary ward,the DRG core indicators were analyzed by the Medical Records and Statistics Division,whereas the health insurance cost data were analyzed by the Health Care Division.The result showed that different specialized⁃disease wards of the Cardiovascular department operate with their own characteristics.The electrophysiological disease ward has great difficulty in interventional operation and a high cost of health insurance.In contrast,the coronary heart disease ward is characterized by as low cost of health insurance and quick patient turnover.Compared with the general disease ward,the specialized⁃disease ward has a higher concentration of patient types and a higher number of patients requiring surgical operations.Through proper construction of specialized⁃disease wards,the optimization of department operation,the promotion of academic development,and the intensification of cost control could all be achieved as a new way of development and operation for the future of the cardiovascular department.

关 键 词：DRG 心血管内科 医保费用 

分 类 号：R197.3[医药卫生—卫生事业管理]