DRGs付费对高龄股骨转子间骨折患者行人工股骨置换术中医疗行为的影响研究  

Research of the Effect of DRGs on the DoctoRs BehavioRof Elderly Patients with Intertrochanteric Fracture AfteRArtificial Femoral Head Replacement

作　　者：王明友 兰玉平[1] 何忠成 王洪平 陶崎峰[1] 陈春雨 吴飞鹏[1] Wang Mingyou;Lan Yuping;He Zhongcheng(Department of Orthopaedics,Panzhihua Central Hospital,Panzhihua,Sichuan 617000,China.)

机构地区：[1]攀枝花市中心医院骨科,四川攀枝花617000

出　　处：《四川医学》2024年第5期527-533,共7页Sichuan Medical Journal

基　　金：川北医学院2021年度四川省基层卫生事业发展研究中心资助项目(编号:SWFZ21-C-111)。

摘　　要：目的评价DRGs付费对高龄股骨转子间骨折患者行人工股骨头置换术中医疗行为的影响。方法回顾性分析2016年1月至2021年10月在我院收治的高龄股骨转子间骨折行人工股骨头置换术患者,根据DRGs应用前后将其分为对照组与观察组,分析住院费用、住院时间及反映医生医疗行为相关指标。结果对照组纳入82例,观察组纳入98例,两组患者年龄、性别、受伤原因、骨折分型及手术时间等基本资料差异无统计学意义(P>0.05)。DRGs背景下,高龄股骨转子间骨折患者术前等待时间缩短至(4.23±2.03)d,术中出血量、输液量、输血率均较前下降(P<0.05);术后尿管及引流管留置率降低,抗生素使用时间缩短,实现早期下床活动,平均住院日缩短至(15.33±3.93)d,差异均有统计学意义(P<0.05)。住院费用(除去材料费)下降为(25184.71±4223.37)元,降幅为7.86%(P<0.05),其中手术费、麻醉费、治疗费、护理费较前增加,检查费、输血费、其他费用、药品费、床位费、检验费较前降低(P<0.05)。DRGs实施后,在不增加术后并发症发生率和90 d再入院率的基础上,改善术后患髋疼痛及髋关节功能评分,提高患者满意度,差异均具有统计学意义(P<0.05)。结论DRGs付费制度在高龄股骨转子间骨折行人工股骨头置换术患者中的应用可促进医护人员主动学习新理念、新技术,通过强化术前宣教,优化饮食管理、血液管理、疼痛管理、管道管理、体温管理,早期功能锻炼等快速康复理念的应用,在缩短住院时间、降低住院费用的基础上规范了医疗服务提供者的诊疗及收费行为,保障医疗质量的同时提高医疗服务效率,增加患者满意度。Objective To study effects of DRGs on doctor's behavioRof elderly patients with intertrochanteric fracture afteRfemoral head replacement.Methods From January 2016 to OctobeR2021,elderly patients with intertrochanteric fracture of femuRwho underwent artificial femoral head replacemen were divided into control group and observation group according to the application of DRGs before and after,and hospital expenses,hospital stay and related indicators reflecting the medical behavioRof doctors were analyzed.Results There were 82 patients in control group and 98 patients in observation group.There was no statistical difference between two groups in basic data such as age,sex,cause of injury,fracture classification and operation time(P>0.05).UndeRthe background of DRGs,preoperative waiting time of elderly patients with intertrochanteric fracture of femuRwas shortened to(4.23±2.03)d,and intraoperative blood loss,transfusion volume and blood transfusion rate were all loweRthan before(P<0.05).The retention rate of urinary catheteRand drainage tube decreased afteRoperation,the use time of antibiotics was shortened,and the average hospital stay was shortened to(15.33±3.93)d,the differences are statistically significant(P<0.05).The cost of hospitalization(excluding material costs)decreased to(25184.71±4223.37)yuan,with a decrease of 7.86%(P<0.05).The cost of surgery,anesthesia,treatment and nursing increased,and the cost of examinotion,blood transfwsion,otheRexpenses,medicines,beds and tests decreased(P<0.05).AfteRimplementation of DRGs,on the basis of not increasing the incidence of postoperative complications and the 90-day readmission rate,scores of postoperative hip pain and hip joint function were improved,and patients'satisfaction was improved with statistically significant difference(P<0.05).Conclusion The application of DRGs in elderly patients with intertrochanteric fracture undergoing artificial femoral head replacement could promote medical staff to actively learn new concepts and new technologies,and optimize th

关 键 词：快速康复 疾病诊断相关分组 高龄 股骨转子间骨折 置换 医疗行为 应用与研究 

分 类 号：R684.3[医药卫生—骨科学]