HIV/AIDS 病人疾病诊断相关分组效果评价与异常费用分析  

Evaluation of DRG grouping effect diagnosis relcaed groupsgrouping effect and influencing factors for abnormalcosts in HIV/AIDS patients

作　　者：孙梗钤 卿勇[3] 蒋建军 周晓羽[1,2] 李朝娟 陈丹镝 SUN Gengqian;QING Yong;JIANG Jianjun;ZHOU Xiaoyu;LI Chaojuan;CHEN Dandi(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China.;Center for Palliative Medicine,West China-Xiehe Chen Zhiqian Institute of Health and Wellness,Sichuan University,Chengdu 610041,Sichuan Province,China.;Chengdu Anorectal Specialist Hospital,Chengdu 610017,Sichuan Province,China.)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,成都610041 [2]四川大学华西-协和陈志潜卫生健康研究院,姑息医学中心,成都610041 [3]成都肛肠专科医院,成都610017

出　　处：《预防医学情报杂志》2023年第5期540-545,550,共7页Journal of Preventive Medicine Information

基　　金：川财艾滋病等重大疾病防治专项(项目编号:2019卫健委-10)。

摘　　要：目的评价艾滋病病毒感染者及病人(People Living with HIV/AIDS,PLWHA)的CHS-DRG分组效果,分析费用结构和异常费用的影响因素,为推进医保支付方式改革提供依据。方法使用变异系数(CV)和方差减少量(RIV)对2020年1月1日至2022年7月1日成都市2所三甲医院的406例PLWHA患者CHS-DRG分组效果进行评价;通过计算不同病例组的费用和时间消耗指数评价各组医疗效率,以医疗效率较好的病例组为对照,通过结构变动值、结构变动度和结构变动度贡献率分析各病例组的费用结构;运用SPSS 17.0构建无序多分类Logistic回归模型分析异常费用的影响因素,检验水准α=0.05。结果PLWHA共分为5个CHS-DRG病例组,各病例组住院费用CV均<1,组间RIV<0.4;除YC13组外,其余病例组费用消耗指数均>1;各病例组药品费所占比重较高,相较于YC13,YC11、YC15、YR11和YR29的结构变动度分别为19.42%、11.82%、11.54%和7.23%;影响PLWHA费用异常的因素为其它诊断个数、手术个数和住院时间倍率。结论需继续优化成都地区PLWHA患者CHS-DRG分组方案的本土适用性,调整YC11等药品费比重较高病例组费用结构,细化PLWHA患者DRG分组并根据异常费用影响因素加强绩效考核,降低患者及社会经济负担。Objective To evaluate the CHS-DRG grouping effect for People Living with HIV/AIDS(PLWHA),analyze the cost structure and influencing factors of abnormal costs,and provide a basis for promoting health insurance payment reform.Methods From 1st January to 1st July in 2020,coefficient of variation(CV)and reduction in variance(RIV)were used to evaluate the effect of CHS-DRG grouping in 406 PLWHA patients from 2 tertiary hospitals in Chengdu.The medical efficiency of each group was evaluated by calculating the cost and time consumption indices.Using the case with better medical efficiency as the control group,and the cost structure of each case group was analyzed by the value of structural change,degree of structural change and contribution rate of structural change.A multinomial logistic regression model was established to analyze the influencing factors of abnormal costs by using SPSS 17.0.The test level was set asα=0.05.Results PLWHA was divided into 5 CHS-DRG groups,and the CV of hospitalization cost was less than 1 in all groups,and the RIV between those groups was less than 0.4.Except for the YC13 group,the cost consumption index was greater than 1 in all groups.Higher proportion of drug costs were observed in each of those groups.Compared with YC13,the degree of structural change of YC11,YC15,YR11 and YR29 was 19.42%,11.82%,11.54%and 7.23%,respectively.Influencing factors of cost abnormalities in PLWHA were the number of other diagnoses,the number of procedures and the length of stay multiplier.Conclusions It is necessary to continue to optimize the local applicability of the CHS-DRG grouping scheme for PLWHA patients in Chengdu,adjust the cost structure of the case group with a high proportion of drug costs such as YC11,refine the DRG grouping of PLWHA patients and strengthen the performance assessment based on influencing factors of abnormal costs to reduce the economic burden on patients and society.

关 键 词：CHS-DRG 艾滋病 HIV 住院费用 

分 类 号：R512.91[医药卫生—内科学]