某三级专科医院DRG分组高倍率病例费用影响因素比较分析  

Comparative analysis of factors affecting the cost of high rate cases in DRG group in a tertiary specialized hospital

作　　者：付文鹏[1] 徐亮[1] 卢诚震[1] FU Wenpeng;XU Liang;LU Chengzhen(Tianjin Second People's Hospital,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院,天津300192

出　　处：《卫生软科学》2024年第5期69-73,共5页Soft Science of Health

基　　金：天津市卫健委科技项目(TJWJ2022XK034)。

摘　　要：[目的]基于天津市某三级专科医院DRG分组数据探讨专科医院DRG组高倍率病例影响因素,为医院进行有针对性的成本控制提供参考。[方法]收集某专科医院2022年10月1日-2023年9月30日上传的医保患者医保结算清单经分组器分组后正常入组数据,按照进入天津市医保局DRG分组器分组后的全市付费次均费用、平均住院天数计算入组病例费用的倍率,应用logistic回归分析高倍率病例的影响因素,采用灰色关联分析法分析高倍率病例各分项费用与住院总费用的关联度。[结果]入组病例总数为7829例,其中高倍率病例673例,占8.60%。Logistic回归结果显示,DRG合并并发症、15~60岁、非医嘱离院、实际住院天数长是高倍率病例产生的影响因素(P<0.05)。灰色关联结果显示,在10个高倍率的DRG组里,有5个DRG组的诊断费与其呈现最强的相关性,有3个DRG组的药品费与其呈现最强的相关性,有2个DRG组的综合服务费与其呈现最强的相关性。[结论]药品费、诊断费、综合服务费、合并并发症、15~60岁及住院天数长与高倍率住院费用的产生显著相关,是医院进行有指向性成本控制的重要因素。Objective Based on the data of DRG group in a tertiary specialized hospital in Tianjin,the influencing factors of high rate cases in DRG group in a specialized hospital were discussed to provide the scientific basis for targeted cost control in hospitals.Methods Data that were grouped by the grouping tool from settlement lists of the medical insurance of patients in a specialized hospital from October 1,2022 to September 30,2023 were collected.The cost ratio of enrolled cases was calculated according to the average DRG payment per admission and the average length of stay in Tianjin by the DRG grouping of Tianjin Medical Insurance Bureau.The influencing factors of high rate cases were analyzed by logistic regression,and the grey correlation analysis method was applied to analyze the correlation between various costs and the total hospitalization cost of high rate cases.Results The total number of admitted cases was 7829,of which 673 were high rate cases,accounting for 8.60%.The results of logistic regression analysis showed that DRG complications,15-60 years old,hospital discharge against doctor's advice and long length of hospital stay were influencing factors of high rate cases(P<0.05).The results of grey correlation analysis showed that among the ten high rate DRG groups,the diagnostic fees had the highest correlation in five DRG groups;drug costs had the highest correlation in three DRG groups,and comprehensive service costs had the highest correlation in two DRG groups.Conclusions Drug costs,diagnostic costs,comprehensive service fees,complications,15-60 years of age and long length of hospital stay are significantly correlated with high rate hospitalization costs,which are important factors for hospitals to control cost accordingly.

关 键 词：医保DRG付费 高倍率病例 成本控制 

分 类 号：R197.32[医药卫生—卫生事业管理] R197.1[医药卫生—公共卫生与预防医学]