河南省某三甲医院肾内科DIP付费制度实施情况分析  

Analysis of Implementation of DIP Payment in Nephrology Department of a Tertiary Hospital in Henan Province

作　　者：李鑫 陈献振 王莹莹[1,2] 许丹 滕俊玲 LI Xin;CHEN Xian-zhen;WANG Ying-ying;XU Dan;TENG Jun-ling(Henan Provincial People's Hospital;Zhengzhou University People's Hospital)

机构地区：[1]河南省人民医院 [2]郑州大学人民医院

出　　处：《医院管理论坛》2024年第2期15-18,共4页Hospital Management Forum

摘　　要：目的探讨河南省某三甲医院肾内科2020一2022年出院病历优势病种和手术操作组合,分析该科室DIP付费制度实施情况。方法提取2020一2022年肾内科出院病历病案首页基本信息数据进行描述性分析,采用χ^(2)检验、Fisher's确切概率法比较分析不同年份手术操作率的差异、不同年份出院病历治疗效果的差异。结果该院肾内科前6位病种为慢性肾脏病5期贫血、肾病综合征伴膜性肾小球肾炎、慢性肾脏病5期、肾病综合征、人工动静脉瘘狭窄和狼疮性肾炎;与前两年相比,2022年肾内科出院病历前3位病种7组病种组合中6组次均费用均降低;前6位病种中4个病种在3年间的手术操作占比差异有统计学意义(p<0.05),且2022年手术操作率均为最高;2020一2022年间出院病历主要诊断治愈/好转率逐渐上升。结论DIP付费制度的实施降低了医疗费用,减轻了患者疾病负担,提升了临床诊治能力,协助推动了医疗机构精益运营管理模式的建立。Objective To explore the dominant diseases and surgical operation combinations in the discharge medical records of the nephrology department of a tertiary hospital in Henan Province from 2020 to 2022,and to analyze its implementation of DIP payment system.Methods The basic information of the front sheet of discharge medical records of the nephrology department from 2020 to 2022 were extracted for descriptive analysis.χ^(2)test and Fisher's exact probability method were used to compare and analyze the differences in surgical operation rate and treatment effect of discharge medical records in different years.Results The top six diseases in the nephrology department of the hospital were anemia of chronic kidney disease stage 5,nephrotic syndrome with membranous glomerulonephritis,chronic kidney disease stage 5,nephrotic syndrome,artificial arteriovenous fistula stenosis and lupus nephritis.Compared with the previous two years,the average cost per visit of 6 groups of 7 disease combinations of the top 3 diseases in nephrology discharge records in 2022 decreased.Four of the top six diseases had statistically significant differences in the proportion of surgical operations during the three years(p<0.05),and the surgical operation rate was the highest in 2022.From 2020 to 2022,the cure/improvement rate of the main diagnosis in discharge medical records gradually increased.Conclusion The implementation of DIP payment system has reduced medical expenses,reduced patients disease burden,improved clinical diagnosis and treatment capabilities,and helped promote the establishment of lean operation management mode of medical institutions.

关 键 词：肾内科 病种分值付费 病种和手术操作 次均费用 

分 类 号：R197.3[医药卫生—卫生事业管理]