日间手术方式管理及结算模式的改进效果  

Improvement effect of day surgery management and settlement mode

作　　者：孙泽勇[1] 蒋丽莎[2] SUN Zeyong;JIANG Lisha(Department of Finance,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China;Day Surgery Service Center,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院财务部,四川省成都市610041 [2]四川大学华西医院日间服务中心,四川省成都市610041

出　　处：《广西医学》2023年第24期3024-3028,共5页Guangxi Medical Journal

基　　金：国家自然科学基金(72104161);四川省自然科学基金(2023NSFSC1048)。

摘　　要：目的 基于两类手术分析日间手术管理及结算模式的改进效果。方法 选取2012年1—12月收治的263例日间手术患者作为对照组,选取2021年12月至2022年5月收治的210例日间手术患者作为观察组。对照组和观察组中分别有97例、61例患者在局部麻醉下行成人无张力疝修补术(单侧),分别有166例、149例在全身麻醉下行腹腔镜胆囊切除术。对照组采用常规的日间手术管理与结算模式;观察组基于多学科手术平台、加速康复外科理念及PDCA理论优化日间手术管理模式,并在完善“互联网+医疗”建设的的基础上推行电子发票和出院一体化快速结算。比较两组患者两种日间手术各项费用的构成比、变动率,以及人均出院费用结算时间及患者结算满意度。结果 在成人无张力疝修补术(单侧)中,相较于对照组,观察组的药费、材料费、床位费及其他费用均有所降低,手术费、麻醉费、化验检查费、治疗费、护理费均有所增加,而人均住院费用及自付费用降低。在腹腔镜胆囊切除术中,相较于对照组,观察组的药费、化验检查费、材料费及其他费用均有所降低,手术费、麻醉费、治疗费、床位费、护理费、人均住院费用均有所增加,而自付费用则降低。观察组人均出院费用结算时间短于对照组,患者结算满意度高于对照组(P<0.05)。结论 改进日间手术的管理及结算模式可优化住院费用的构成,更好地体现医护人员的劳动价值,降低患者自身承担的医疗负担,并可缩短出院费用结算时间,提高患者的结算满意度。Objective To analyze the improvement effect of day surgery management and settlement mode based on the two categories of surgery.Methods A total of 263 patients undergoing day surgery admitted from January to December 2012 were selected as control group,and 210 patients receiving day surgery admitted from December 2021 to May 2022 were selected as observation group.In the control group and the observation group,97 and 61 patients underwent adult tension-free hernia repair(unilateral)via local anesthesia,and 166 and 149 patients underwent laparoscopic cholecystectomy via general anesthesia,respectively.The control group received routine day surgery management and settlement mode,whereas the observation group optimized day surgery management mode based on the multidisciplinary surgery platform,concept of enhanced recovery after surgery and PDCA theory,and implemented the integration of electronic invoice and discharge rapid settlement on the basis of improving the construction of"Internet+healthcare".The constituent ratio and change rate of various expenses of the two categories of day surgery,as well as per capita discharge expense settlement time and patient settlement satisfaction were compared between patients of the two groups.Results In adult tension-free hernia repair(unilateral),compared with the control group,medicine expense,material expense,bed expense,and other expenses of the observation group were reduced,operation expense,anesthesia expense,laboratory examination expense,treatment expense,and nursing expense were increased,whereas the per capita hospitalization expense and patients′self-medical burden were reduced.In laparoscopic cholecystectomy,compared with the control group,drug expense,laboratory examination expense,material expense,and other expenses of the observation group were reduced,operation expense,anesthesia expense,treatment expense,bed expense,nursing expense,and per capita hospitalization expense were increased,but patients′self-medical burden was decreased.The per capita discharg

关 键 词：日间手术 管理模式 结算模式 无张力疝修补术 腹腔镜胆囊切除术 费用构成 结算时间 满意度 

分 类 号：R61[医药卫生—外科学] R197.32[医药卫生—临床医学]