DRG低倍率病例的特征、产生原因与优化建议:以肿瘤专科医院RG13分组为例  

Characteristics, Causes and Optimization Suggestions of Low-rate Cases in DRG Payment: the Example of RG13 Grouping in a Cancer Hospital

作　　者：柳嘉玮 徐思露 张倩[2] 白兆石 季花[2] 魏继福 LIU Jiawei;XU Silu;ZHANG Qian;BAI Zhaoshi;JI Hua;WEI Jifu(Department of Pharmacy,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Finance,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院药学部,南京210009 [2]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院财务处,南京210009

出　　处：《药学与临床研究》2023年第4期369-373,共5页Pharmaceutical and Clinical Research

基　　金：江苏省药学会-奥赛康医院药学科研基金(A202202);南京药学会-常州四药医院药学科研基金(2022YX014);江苏省肿瘤医院院基金项目(ZG202102)。

摘　　要：目的:探究肿瘤患者的疾病诊断相关分组(DRG)低倍率病例的特征及产生原因,提出DRG支付机制优化建议,为推动DRG付费工作高效健康发展提供参考。方法:回顾性分析江苏省肿瘤医院DRG-RG13(恶性增生性疾患的靶向、免疫治疗,伴并发症或合并症)分组的患者医疗信息,分析低倍率病例产生原因。结果:RG13分组的低倍率病例区别于正常倍率病例的指标包括癌症病种、平均住院天数、平均住院费用、医疗费用结构等;其中医疗费用中药品费用差异最大,低倍率病例的药品费用约为正常倍率的1/4。患者自备药品使用、抗肿瘤治疗方案简单致住院时间短、患者参与临床试验等药物治疗行为可导致低倍率病例的发生。结论:优化院内药品目录,严格管理自备药品使用,积极推行日间化疗和细化DRG分组方案是减少RG13分组的低倍率病例产生的可行措施。Objective:To investigate the characteristics and causes of low-rate cases under the diagnosis-related groups(DRGs)among cancer patients,and to propose the optimization of DRG payment mechanism to provide a reference for promoting the efficient and healthy development of DRG payment.Methods:The medical information of patients in the DRG-RG13 subgroup(targeted,immunotherapy for malignant proliferative disorders with complications or comorbidities)of Jiangsu Cancer Hospital was retrospectively analyzed,and the investigators independently conducted an analysis of the causes of low-rate cases and discussed them in a unified way.Results:DRG low-rate cases in the RG13 subgroup were statistically different from DRG normal-rate cases in terms of cancer disease type,average hospitalization time,average hospitalization expenses,and composition of medical expenditure.Among the medical expenditure,the difference in drug expenses is the largest,and the drug expenses for low-rate cases are about 1/4 of the normal rate.Drug therapy behaviors such as use of medicines brought into hospital by patients,simple anti-tumor regimens leading to short hospital stays,and patient participation in clinical trials could cause the occurrence of low-rate cases.Conclusion:Optimizing the hospital drug catalogue,strictly managing the use of medicines brought into hospital by patients,actively implementing daytime chemotherapy and refining DRG grouping scheme are feasible measures to reduce the occurrence of low-rate cases in the RG13 subgroup.

关 键 词：诊断相关分组 低倍率病例 肿瘤治疗 

分 类 号：R95[医药卫生—药学]