DRG付费下康复患者住院费用和住院天数的影响因素研究——基于双反应变量多水平模型  

Study on the Influencing Factors of Hospitalization Costs and Hospitalization Days of Rehabilitation Patients under DRG Payment——Based on Two-response Variable Multilevel Model

作　　者：吴妮 周晓媛 王寓凡 WU Ni;ZHOU Xiaoyuan;WANG Yufan(West China College of Public Health/West China Fourth Hospital,Sichuan University,Chengdu Sichuan 610041,China;不详)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,四川成都610041

出　　处：《卫生经济研究》2024年第6期72-77,共6页

基　　金：科技部国家重点研发计划“健康管理综合服务应用示范”(2020YFC2006500);成都市DRG支付方式改革研究采购项目“成都市DRG支付方式改革研究”(SQBX-2023-1105)。

摘　　要：目的:分析康复住院患者的住院费用和住院天数的影响因素并比较影响程度,为推进医保支付方式改革提出建议。方法:选取2020—2021年四川省193家医院收治的康复病例,采用双反应变量多水平混合效应模型,分析不同医院、患者住院费用和住院天数的差异及其影响因素。结果:医院级别与类型、是否纳入DRG付费、核心疾病诊断相关组(ADRG)分组,患者的性别、年龄、手术等级、合并症与并发症,均是影响两反应变量的重要因素;其中,年龄、合并症与并发症、三四级手术、医院级别与类型主要影响住院费用,DRG付费、ADRG分组(BX1除外)、性别、一二级手术主要影响住院天数。结论:不同因素对康复患者住院费用和住院天数的影响程度不同,医院应在住院费用和住院天数控制策略上有所侧重,加强对康复患者ADRG分组管理的同时,积极探索适合康复病例的医保支付模式。Objective To analyze the influencing factors of hospitalization cost and hospitalization days of rehabilitation inpatients and compare the degree of influence,and to make suggestions for promoting the reform of health insurance payment method.Methods Rehabilitation cases admitted to 193 hospitals in Sichuan Province from 2020 to 2021 were selected to analyze the differences in hospitalization costs and hospitalization days among different hospitals and patients and their influencing factors by using a two-response variable multilevel mixed-effects model.Results Hospital level and type,inclusion in DRG payment,grouping of Adjacent Diagnosis Related Groups(ADRG),patient gender,age,surgical grade,complication and comorbidity were all important factors affecting the two-response variable.Among them,age,comorbidities and complications,tertiary and above level surgeries,and hospital level and type mainly affected hospitalization expenses.DRG payment,ADRG grouping(excluding BX1),gender,primary and secondary surgeries mainly affected hospitalization days.Conclusion Different factors have different degrees of influence on the hospitalization cost and hospitalization days of rehabilitation patients.Hospitals should focus on the control strategy of hospitalization cost and hospitalization days.While strengthening the management of ADRG grouping of rehabilitation patients,hospitals should actively explore the health insurance payment model suitable for rehabilitation cases.

关 键 词：按疾病诊断相关分组付费 康复患者 双反应变量多水平模型 

分 类 号：F840.684[经济管理—保险]