内眼手术DRG分组效果评价及费用影响因素分析  

Analysis on the DRG Grouping Efficiency Evaluation and Costs Influencing Factors of Intraocular Surgery Patients

作　　者：于磊 任芝莉 邓活清 肖南希 王湛泽 徐子蕴 Yu Lei;Ren Zhili;Deng Huoqing;Xiao Nanxi;Wang Zhanze;Xu Ziyun(Huadu District People's Hospital Affiliated to Southern Medical University,Guangzhou 510800,Guangdong Province,China;不详)

机构地区：[1]南方医科大学附属花都医院,广东省广州市510800

出　　处：《中国病案》2023年第8期44-48,共5页Chinese Medical Record

基　　金：广州市卫生健康科技项目(20221A011116);广州市花都区医疗卫生一般科研专项项目资助(21-HDWS-038);南方医科大学附属花都医院科研基金(2021C14,2021C13)。

摘　　要：目的评价内眼手术患者DRG分组效果并探究影响患者费用的因素,为降低眼疾患患者医疗费用负担和推广DRG医院管理提供参考依据。方法采用变异系数和方差减少量评价内眼手术患者DRG分组效果;利用费用和时间消耗指数评价医用耗材零加成前后内眼手术患者的医疗效率差别;利用无序多分类logistic回归分析影响内眼手术患者费用异常的主要因素。结果4个内眼手术DRG组为CB19、CB29、CB39和CB49,住院总费用和时间的CV和RIV值显示DRG分组效果良好。耗材零加成后,CB19、CB29、CB39和CB49组患者的费用消耗指数为0.72、0.49、0.93和0.57,同比实施前减少0.12、0.28、0.02和0.01;CB19和CB29组患者的时间消耗指数分别为0.51和0.79,同比减少0.28和0.33;CB39和CB49患者的时间消耗指数为0.89和1.12同比上升0.04和0.22,这两组患者的住院时间同比实施前都有减少,只是减少的程度没有广东省标杆值减少的大。影响内眼手术患者费用异常类型的因素:年龄组、住院天数组、是否零加成期病例、是否临床路径病例、是否高药占比、是否高耗占比、入院途径、其他诊断个数、全部手术个数。结论DRG在广东地区适用性较好;耗材零加成政策可以降低患者的住院费用;处于45~59岁和60~74岁,长住院时间,耗材零加成,高药、耗占比,急诊入院,多合并症及手术都是导致内眼手术患者高费用的因素。Objectives To evaluate the grouping effect of DRGs in patients received intraocular surgery and explore the factors affecting patient costs,so as to provide reference for reducing the burden of medical costs for patients with eye diseases and promoting hospital management of DRGs.Methods Coefficient of variation and variance reduction were used to evaluate the DRG grouping effect of patients undergoing intraocular surgery.The cost and time consumption index were used to evaluate the difference of medical efficiency in patients received intraocular surgery before and after zero addition of medical consumables.The disordered multiple logistic regression was used to analyze the main factors affecting the abnormal cost of patients received intraocular surgery.Results The four DRG groups of internal eye surgery were CB19,CB29,CB39 and CB49.The CV and RIV values of total hospital expenses and time showed a good effect of DRG grouping.After zero addition of consumables,the cost consumption index of patients in CB19,CB29,CB39 and CB49 groups was 0.72,0.49,0.93 and 0.57,which decreased by 0.12,0.28,0.02 and 0.01 compared with that before the implementation.The time consumption index of CB19 and CB29 groups was 0.51 and 0.79,respectively,which decreased by 0.28 and 0.33 compared with the same period last year.The time consumption index of patients with CB39 and CB49 was 0.89 and 1.12,which increased by 0.04 and 0.22 compared with the same period last year.The length of hospitalization stay of patients in these two groups decreased compared with that before the implementation,but the degree of reduction was not as great as that of benchmark value in Guangdong Province.Factors influencing the abnormal cost types of patients with intraocular surgery include age group,hospital stay group,cases with or without zero addition period,cases with or without clinical pathway,cases with or without high drug proportion,cases with or without high consumption proportion,admission route,number of other diagnoses,and number of all operatio

关 键 词：DRG 内眼手术 耗材零加成 费用异常原因 LOGISTIC回归 

分 类 号：R779.6[医药卫生—眼科] R197.3[医药卫生—临床医学]