基于CHS-DRG的经皮冠状动脉支架植入按病组结算影响因素研究  

Research on Influencing Factors of Percutaneous Coronary Stent Implantation by Group Settlement Based on CHS-DRG

作　　者：杨伯钊[1] 韩优莉[2] 马海洋[1] 耿倩 魏文斌[1] Yang Bozhao;Han Youli;Ma Haiyang(Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing,100730,China;不详)

机构地区：[1]首都医科大学附属北京同仁医院,北京100730 [2]首都医科大学公共卫生学院,北京100069

出　　处：《中国医院管理》2023年第12期20-24,28,共6页Chinese Hospital Management

摘　　要：目的分析北京某医院经皮冠状动脉支架植入(FM19)病组数据,为推进CHS-DRG付费改革提供数据支撑,并对其精细化管理提供指导及借鉴。方法统计并分析某医院2020年1月—2021年12月间接受经皮冠状动脉支架植入治疗的北京市本地医保患者病例数据,统计入选患者的医保结算信息,并对影响其进入FM19病组结算的因素进行分析。结果影响FM19的入组因素在不同改革阶段存在差异,超转人员是实际运行阶段中一个新的干扰病组结算的独立因素。某些特殊操作码由于病组间的优先级效应可干扰病例进入FM19病组。结论CHS-DRG的入组结算条件更为复杂,不同费用类型患者需根据当前分组方案结合报销政策具体分析。目前对于城镇居民医保按打包结算的病组相对较少,并持续受到分组优先级规律的影响。但对于城镇职工则需全面落实并加强病组控费,合理优化诊疗方案以精细化管控医疗成本。Objective To analyze the data of percutaneous coronary stent implantation related groups in certain hospital of Beijing,so as to provide data support for promoting CHS-DRG payment reform and provide guidance and reference for its refined management.Methods The case data of local medical insurance patients in Beijing who received percutaneous coronary stent implantation from January 2020 to December 2021 in certain hospital were statistically analyzed,collect the medical insurance settlement information of the selected patients,and analyze the factors that affect their entry into FM19 group settlement.Results There are differences in the factors affecting FM19 inclusion in different reform stages,overtransfer personnel is a new independent factor that interferes with the group settlement in the actual operation stage.Some special operation codes may interfere with cases entering FM19 group due to priority effect among disease groups.Conclusion The grouping settlement conditions of CHS-DRG are more complex,patients with different expense types need to be specifically analyzed according to the current grouping scheme and reimbursement policy.At present,there are relatively few disease groups settled by package for urban residents,and they continue to be affected by the rule of grouping priority.However,it is necessary to fully implement and strengthen the cost control of disease groups for urban employees,and rationally optimize the diagnosis and treatment plan to finely control medical costs.

关 键 词：疾病诊断相关分组 经皮冠状动脉支架植入 结算方式 

分 类 号：R197.1[医药卫生—卫生事业管理]