基于细化疾病诊断相关分组病种临床路径管理方案的制订及实施效果分析  

Research on the formulation and implementation of clinical pathway management plan based on detailed DRG disease

作　　者：王玉廷[1] 周小兰[1] 阳文琳[1] WANG Yuting;ZHOU Xiaolan;YANG Wenlin(Department of Medical Records Statistics,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院病案统计科,重庆400010

出　　处：《检验医学与临床》2023年第8期1068-1071,共4页Laboratory Medicine and Clinic

基　　金：2022年重庆市卫生健康委员会医学(含中医药类)科研项目(2022WSJK109)。

摘　　要：目的探讨基于细化疾病诊断相关分组(DRG)病种临床路径管理方案的制订及其效果分析。方法将重庆市医疗保障局DRG后的数据进行经济学分析,筛选出重点管控病组。将DRG病组进行细分,将细分后的病种采用信息化手段进行大数据分析、数据挖掘及关键指标设定、标杆设置的方法、专家论证、过程管理等方法匹配及优化目标病种的最佳临床路径,比较评估临床路径效果,形成一套基于DRG细分病种的最佳临床路径系统。结果按照基于DRG的临床路径管理方案实施管控后,髋关节置换术患者例均总费用较未实施该方案降低30924.28元,例均耗材费下降28500.02元,例均药品费下降3529.42元。实施基于DRG的临床路径管控前后医院平均费率从13198.51元/权重降至11875.65元/权重,降低了1322.86元/权重,下降了10.02%。结论通过细化DRG的临床路径管控方案可降低医疗费用、规范医疗行为、提升医疗效率,使医疗资源分配合理化,提高医保基金的使用效益。Objective To explore the formulation and effect analysis of clinical pathway management based on detailed diagnosis Related Groups(DRG)diseases.Methods The data of Chongqing Medical Insurance Bureau DRG group were analyzed by economics,and the key control disease groups were selected.By subdividing the DRG disease group,the subdivided disease types were matched and optimized by big data analysis,data mining,key index setting,benchmarking setting,expert demonstration,process management and other methods,so as to compare and evaluate the effect of clinical path,and form an optimal clinical path system based on DRG subdividing disease types.Results After the implementation of clinical pathway management scheme based on DRG,the average cost of hip replacement patients decreased by 30924.28 yuan,the average cost of consumables decreased by 28500.02 yuan and the average cost of drugs decreased by 3529.42 yuan.Before and after the implementation of clinical evidence control based on DRG,the average hospital rate decreased from 13198.51 yuan/weight to 11875.65 yuan/weight,decreasing 1322.86 yuan,down 10.02%.Conclusion By refining the clinical pathway control scheme of DRG,medical costs can be reduced,medical behavior can be standardized,medical efficiency can be improved,medical resource allocation can be rationalized,and medical insurance fund utilization efficiency can be improved.

关 键 词：疾病诊断相关分组 成本管理 临床路径 

分 类 号：R197.323[医药卫生—卫生事业管理]