基于DRG的缺血性脑卒中患者分组效果及住院费用分析  

Analysis of grouping effect and hospitalization cost of patients with ischemic stroke based on DRG

作　　者：陈宇 常人元 王盼[1] 贾爱华[1] 封婷[1] Chen Yu;Chang Renyuan;Wang Pan;Jia Aihua;Feng Ting(The First Hospital of Yulin,Yulin 719000,China)

机构地区：[1]榆林市第一医院,陕西榆林719000

出　　处：《中国医院统计》2023年第6期457-460,共4页Chinese Journal of Hospital Statistics

基　　金：榆林市科协青年人才托举计划项目(20220438)。

摘　　要：目的分析缺血性脑卒中患者DRG分组效果、住院费用构成和结构变动情况,为DRG付费改革的实施和精准控费提供依据。方法运用变异系数和秩和检验评价DRG组内变异和组间异质性;利用结构变动度分析住院费用的结构变动情况。结果缺血性脑卒中各DRG组的CV均小于1,3组间住院费用比较差异有统计学意义(P<0.001),3组间住院天数比较差异无统计学意义(P=0.857)。各组药品费占比最高,达40%以上;其次是诊断费,达30%以上。BR21与BR25组比较结构变动度最大(10.86%),BR21与其他组比较治疗费结构贡献率最大,BR25与其他组比较药品费结构贡献率最大。结论缺血性脑卒中分组较合理,但费用结构尚需优化。应该上调医疗服务型项目的收费标准,规范临床路径,建立与DRG付费相适应的绩效考核方案和合理有效的控费机制。Objective To analyze the grouping effect of DRG,the hospitalization costs composition and structural changes in patients with ischemic stroke,so as to provide basis for the implementation of DRG payment reform and precise fee control.Methods The intra-group variation of DRG was evaluated by coefficient of variation(CV),and the inter-group comparison was evaluated by rank sum test;the structural change of hospitalization expenses between DRG groups was analyzed by the structural change degree.Results The CV of each DRG group was less than 1;the difference of hospitalization expenses among the three groups was statistically significant(P<0.001),while the difference of hospitalization days among the three groups was not statistically significant(P=0.857);the proportion of drug costs in each group was the highest,reaching over 40%,followed by the diagnostic fee,which reached over 30%.The structure of BR21 compared with BR25 had the largest variation(10.86%),the treatment cost structure of BR21 compared with other groups had the largest contribution rate,and the drug cost structure of BR25 compared with other groups had the largest contribution rate.Conclusion The grouping effect of ischemic stroke is reasonable,but the cost structure still needs to be optimized.We should raise the charging standard for medical service projects,standardize the clinical pathway,and establish a performance evaluation scheme and a reasonable and effective cost control mechanism that are compatible with DRG payment.

关 键 词：缺血性脑卒中 疾病诊断相关分组 分组效果 费用分析 

分 类 号：R197.3[医药卫生—卫生事业管理]