DRG高倍率病例特征分析及管理建议  

Cause Analysis and Policy Optimization of DRG High-Rate Cases

作　　者：纪门 孔旭辉 黄秀芹 张磊[1] JI Men;KONG Xuhui;HUANG Xiuqin;ZHANG Lei(Taizhou People's Hospital Affiliated to Nanjing Medical University,Taizhou Jiangsu 225300,China)

机构地区：[1]南京医科大学附属泰州人民医院,江苏泰州225300

出　　处：《卫生经济研究》2023年第1期78-82,共5页

基　　金：江苏省医院协会专项研究课题“DRG点数法付费改革实施效果实证研究”(JSYGY-2-2021-PJ96);江苏省医院协会医院管理创新研究课题“DRG点数法付费改革对医院运营效率的影响研究”(JSYGY-3-2021-59)。

摘　　要：目的:分析高倍率病例特征,提出相应的管理建议。方法:以某三甲综合医院为样本,描述分析高倍率病例特征,采用χ2检验和t检验,从诊疗难易程度、诊疗行为规范性、新技术或特殊项目使用3个维度,比较分析高倍率病例和正常病例之间的差异。结果:2022年1—3月样本医院高倍率病例903例,ADRG分布内科组占比最高;编码错误导致的高倍率病例占比19.6%;高倍率病例在RW值、并发症/合并症数量、手术分级、危重病例、院内转科、临床路径管理、新技术或特殊项目使用等方面与正常病例之间存在显著性差异。结论:提高病案首页质量,加强高倍率病例临床路径的分析及应对,科学制定高倍率病例认定标准,对使用新技术或特殊项目的高倍率病例给予倾斜支持,加强高倍率病例审核和监管,规避高倍率政策道德风险。Objective To describe the characteristics of high-rate cases and put forward policy optimization.Methods A tertiary general hospitil was chosen to describe the characteristics of high-rate cases.We employed chi-square test and t test to compare the differences between high-rate cases and normal cases from disease difficulty,diagnosis and treatment standardization,and usage of new technology or new projects.Results From January to March,2022,903 cases of high-rate cases were included in this study.The proportion of ADRG distribution in internal medicine group ranked first.There were 19.6%of the cases divided into high rate groups due to coding error.Significant differences were observed between high-rate cases and normal cases in RW value,number of complications,surgical classification,critical cases,hospital transfer,clinical pathway management and usage of new technologies or special projects.Conclusion It is recommended to improve the quality of the homepage of medical records,improve the strategic response and supporting policies for the clinical pathway of high-rate cases,strengthen the review and supervision measures of high-rate cases,and avoid the moral hazard of high-rate cases.

关 键 词：高倍率病例 DRG 病案首页 临床路径 

分 类 号：R197.32[医药卫生—卫生事业管理]