艾滋病病例的DRG分组效果及费用影响因素分析  

Analysis of DRG grouping effect and cost influencing factors of AIDS cases

作　　者：华乐 马文骏 马燕蓉 HUA Le;MA Wenjun;MA Yanrong(The Hangzhou Xixi Hospital,Hangzhou 310023,China)

机构地区：[1]杭州市西溪医院,浙江杭州310023

出　　处：《现代医院》2023年第3期395-398,共4页Modern Hospitals

基　　金：杭州市卫生科技计划重点项目(ZD20200005)。

摘　　要：目的分析艾滋病病例疾病诊断相关分组(diagnosis-related groups,DRG)的分组效果、组间费用结构变动情况及其影响因素,为本地区DRG组合付费的实施提供参考。方法以某三甲传染病专科医院2020—2021年1008份艾滋病病例为研究对象,运用变异系数(CV)、方差减少量(RIV)、Kruskal-Wallis H秩和检验、Nemenyi法等对分组合理性进行评价,采用结构变动度分析费用结构变动情况,最后用多元线性回归分析探讨住院费用的影响因素。结果艾滋病DRG分组费用结构不合理,住院费用的组内同质性较低(CV>1),组间异质性较差(RIV=11.41%<70%),且各分组费用结构变动度不大,均<1%;住院天数、是否入住过ICU、并发症个数、有无手术是住院费用的主要影响因素。结论应建立健全的病案质量控制体系,加强病案首页质量控制,提高DRG入组准确性;完善艾滋病临床管理路径以缩短住院日;强化早期抗病毒治疗以预防并发症;建立灵活弹性的手术方式选择机制;加强ICU并发艾滋病患者评估以降低ICU入住率。Objective To analyze the effect of DRG grouping,the change of inter group cost structure and its influencing factors in AIDS cases,and to provide reference for the implementation of DRG combination payment in this region.Methods Taking 2020—2021 years and 1008 AIDS cases in a tertiary infectious disease hospital as the research object,we used the coefficient of variation(CV),variance reduction(RIV),Kruskal-Wallis H rank sum test and Nemenyi method to evaluate the combination rationality.We used structural change analysis to analyze the change of cost structure,and finally used multivariate linear regression analysis to explore the influencing factors of hospitalization expenses.Results The cost structure of AIDS DRG group is unreasonable,the homogeneity of hospitalization expenses is low(CV>1),and the heterogeneity between groups is poor(RIV=11.41%<70%).The cost structure changes of each group are not large,less than 1%.The main influencing factors of hospitalization expenses are the length of stay,whether you have been in ICU,the number of complications and whether there is surgery.Conclusion We should establish a sound quality control system of medical records,strengthen the quality control of the first page of medical records,and improve the accuracy of DRG enrollment;Improve the clinical management of AIDS to shorten the length of stay;Strengthen early antiviral treatment to prevent complications;Establish a flexible operation mode selection mechanism;Whether AIDS patients need to stay in ICU should be evaluated to reduce ICU occupancy rate.

关 键 词：疾病诊断相关分组 艾滋病 分组效果 住院费用 影响因素 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R197