CHS-DRG付费制度下药物治疗路径化管理在骨科围手术期合理预防性使用重组人促红细胞生成素的应用效果研究  

Application Effect of Drug Therapy Pathway Management in Rational Prophylactic Use of Recombinant Human Erythropoietin During Orthopedic Perioperative Period Under CHS-DRG Payment

作　　者：崔璨[1] 高化[2] 魏俊丽[3] 吴凡 刘也 王欣 刘佳玉 罗晓[1] CUI Can;GAO Hua;WEI Junli;WU Fan;LIU Ye;WANG Xin;LIU Jiayu;LUO Xiao(Dept.of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Dept.of Orthopedic,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Dept.of Health Insurance Office,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院药学部,北京100050 [2]首都医科大学附属北京友谊医院骨科,北京100050 [3]首都医科大学附属北京友谊医院医疗保险办公室,北京100050

出　　处：《中国医院用药评价与分析》2024年第5期611-614,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：国家卫生健康委医院管理研究所关于2022年医疗质量循证管理持续改进研究项目(No.YLZLXZ22G028)。

摘　　要：目的:探讨基于国家医疗保障疾病诊断相关分组(CHS-DRG)付费方式改革下,围手术期重组人促红细胞生成素(rhEPO)路径化管理在骨科的应用效果。方法:采用德尔菲法,经过2轮计划-执行-检查-行动(PDCA)循环优化,制定了rhEPO药物治疗路径。以2022年3—7月该院骨科住院患者为管理前组,2023年3—7月的患者为管理后组。选取rhEPO使用率最高的8个DRG病种,比较管理前后的效益指标(次均住院费用、次均药品费用、平均住院时间、rhEPO使用合理率、输血率)改善程度。结果:与路径化管理前比较,路径化管理后骨科住院患者的次均住院费用由58 829.79元降至48 259.29元(P<0.05),次均药品费用由3 311.23元降至2 987.52元(P<0.05),平均住院时间由10.1 d缩短至8.05 d(P<0.01),差异均有统计学意义;rhEPO使用合理率由26.27%(62/236)提高至91.54%(238/260),输血率由34.66%(165/476)降至25.57%(169/661)。结论:通过路径化管理模式制定药物标准化方案,可优化资源配置,提高医疗质量,有效改善DRG病种效益指标。OBJECTIVE:To explore the application effect of pathway-based management of recombinant human erythropoietin(rhEPO)injection during orthopedic perioperative period in orthopedics under the reform of China Healthcare Security Diagnosis Related Groups(CHS-DRG)payment system.METHODS:Delphi method was employed,and two rounds of plan-do-check-act(PDCA)cycles were conducted to formulate the drug therapy pathway for rhEPO.Patients hospitalized in orthopedics of the hospital from Mar.to Jul.2022 were extracted as the pre-management group,and patients from Mar.to Jul.2023 were extracted as the post-management group.Eight DRG categories with the highest use rate of rhEPO were selected,and the improvement degree of benefit indicators(average hospitalization cost,average drug cost,average length of stay,rational use rate of rhEPO,blood transfusion rate)before and after management was compared.RESULTS:Compared with before management,the average hospitalization cost of orthopedic inpatients after management decreased from 58829.79 yuan to 48259.29 yuan(P<0.05),the average drug cost decreased from 3311.23 yuan to 2987.52 yuan(P<0.05),the average length of stay reduced from 10.1 d to 8.05 d(P<0.01),with statistically significant differences.The rational use rate of rhEPO increased from 26.27%(62/236)to 91.54%(238/260),blood transfusion rate decreased from 34.66%(165/476)to 25.57%(169/661).CONCLUSIONS:By implementing pathway-based management and formulating standardized drug protocols,resource allocation has been optimized,medical quality has been improved,and the benefit indicators of DRG categories have been significantly enhanced.

关 键 词：疾病诊断相关分组 精细化管理 药物治疗路径 骨科 重组人促红细胞生成素 血液管理 

分 类 号：R969.3[医药卫生—药理学] R973[医药卫生—药学]