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作 者:刘静[1] 吕曼辰 周苑[3] 薛同斌 刘瑶瑶 王浩宇 张钰 田帝 LIU Jing;LYU Manchen;ZHOU Yuan;XUE Tongbin;LIU Yaoyao;WANG Haoyu;ZHANG Yu;TIAN Di(Medical Record Management Department,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;School of Health Management,Anhui Medical University,Hefei 230032,China;Department of Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Emergency Office,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
机构地区:[1]安徽医科大学第一附属医院病案管理科,安徽合肥230022 [2]安徽医科大学第一附属医院应急办公室,安徽合肥230022 [3]安徽医科大学卫生管理学院,安徽合肥230032 [4]安徽医科大学第二附属医院医务科,安徽合肥230601
出 处:《安徽医学》2023年第11期1374-1378,共5页Anhui Medical Journal
基 金:2023年度安徽省高校哲学社会科学研究项目(编号:2023AH040368)。
摘 要:目的基于倾向性匹配分析疾病诊断相关分组(DRG)对胆囊结石合并慢性胆囊炎手术患者住院费用的控费效果。方法收集2021年1月至2022年12月安徽医科大学第一附属医院1010例胆囊结石合并慢性胆囊炎手术患者住院费用数据,按付费方式分为DRG组(n=570)和非DRG组(n=440)。采用描述性统计分析、倾向性评分法、秩和检验,平衡病例间混杂因素后,检验DRG组和非DRG组住院费用情况。结果共纳入1010例病例,经倾向性匹配成功852例。胆囊结石合并慢性胆囊炎患者DRG组与非DRG组年龄、住院天数在匹配前差异有统计学意义(P<0.05)。患者住院费用中,耗材费、药费占比较高。经倾向性匹配后,DRG组与非DRG组住院总费用(Z=7.519,P<0.001)、自费金额(Z=13.903,P<0.001)、医保报销费用(Z=11.561,P<0.001)、综合医疗服务费(Z=2.188,P=0.029)、手术费(Z=2.256,P=0.024)、药费(Z=3.202,P=0.001)、耗材费(Z=2.229,P=0.026)、诊断费(Z=8.263,P<0.001)差异均有统计学意义。结论DRG对胆囊结石合并慢性胆囊炎患者自费金额、综合医疗服务费、手术费、药费、耗材费及诊断费均具有控费效果,且总体对住院费用控费效果较好,但费用结构方面仍存在优化空间。Objective To analyze the effect of DRG on the inpatient cost control of patients with gallbladder stones combined with chronic cholecystitis surgery based on propensity matching.Methods Data on inpatient costs of 1,010 patients with gallbladder stones combined with chronic cholecystitis surgery in a tertiary general hospital in Anhui province from January 2021 to December 2022 were collected and divided into DRG group(n=570)and non-DRG group(n=440)according to different payment methods.Descriptive statistical analysis,propensity score method,and rank sum test were used to test the hospitalization cost of DRG and non-DRG groups after balancing the confounding factors between cases.Results A total of 1,010 cases were included,and 852 cases were successfully matched by propensity score matching.Among them,there were statistically significant differences in age and hospitalization days between the DRG and non-DRG groups of patients with gallbladder stones combined with chronic cholecystitis before matching(P<0.05).Patients’,hospitalization costs accounted for a higher proportion of consumables and medication costs.Statistical tests after propensity matching showed that total hospitalization costs(Z=7.519,P<0.001),out-of-pocket amounts(Z=13.903,P<0.001),health insurance reimbursement(Z=11.561,P<0.001),comprehensive medical services(Z=2.188,P=0.029),surgical costs(Z=2.256,P=0.024),medication(Z=3.202,P=0.001),consumables(Z=2.229,P=0.026),and diagnostics(Z=8.263,P<0.001)all had statistically significant differences.Conclusions DRG has a cost-control effect on out-of-pocket expenses,comprehensive medical service fees,surgical fees,drug fees,consumable fees and diagnostic fees for patients with gallbladder stones combined with chronic cholecystitis,and the overall cost-controlling effect of hospitalization is better,but there is still room for optimization in terms of cost structure.
关 键 词:倾向性匹配法 胆囊结石合并慢性胆囊炎 疾病诊断相关分组 控费
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