肿瘤相关疾病在DRGs结算中定额偏离系数影响因素分析  

Analysis of Factors Affecting the Norm Deviation Coefficient of Tumor-related Diseases in DRGs Settlement

作　　者：张宏瑾[1] Zhang Hongjin(Department of Medical Insurance,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院医保办公室,北京市100020

出　　处：《中国病案》2024年第6期84-86,共3页Chinese Medical Record

摘　　要：目的 通过查找肿瘤相关疾病DRGs组中定额偏离系数异常的组,分析其原因,为医院管理提供数据支持。方法 通过北京市医疗保险信息医院端业务组件调取某医院2023年1月1日-2023年12月31日肿瘤相关疾病患者2418组,以定额偏离系数是否大于0.3将患者分为正常组和非正常组。正常组患者2330例,非正常组患者88例。对2组患者性别、住院时间、是否住ICU、手术治疗、盈亏额、肿瘤分类、主诊医师职称等因素进行单因素方差分析、多元线性回归分析筛选影响定额偏离系数的相关因素。结果 正常组中DRGs组数134组,占比96.36%,非正常组中DRGs组数17组,占比3.64%。单因素分析显示住院时间、是否住ICU、盈亏额具有统计学意义,P<0.05,根据多元回归分析可知,住院时间,住ICU是定额偏离系数的影响因素,P<0.05,正常组总药费1251.65元低于非正常组27 911.82元,总耗材8310.77高于非正常组4403.45元,差异具有统计学意义,P<0.05。结论 住院时间、住ICU是影响DRGs结算中定额偏离系数异常的主要原因,医院方面应规范诊疗,应用临床路径等方式缩短住院时间,同时应用DRGs时,针对重症医学科患者应考虑调整分组权重,更加科学合理分组。Objectives To find the abnormal norm deviation coefficient in DRGs group of tumor-related diseases and analyze its causes,so as to provide data support for hospital management.Methods 2418 groups of patients with tumor-related diseases were recruited from a hospital from January 1st,2023 to December 31st,2023 through the terminal business component of Beijing Medical Insurance Information Hospital,and the patients were divided into normal group and abnormal group according to whether the norm deviation coefficient was greater than 0.3.There were 2330 patients in the normal group and 88 patients in the abnormal group.One-way ANOVA and multiple linear regression analysis were performed on gender,length of stay,ICU admission,surgical treatment,profit and loss,tumor classification,and professional title of attending physicians of the two groups to screen the relevant factors affecting the norm deviation coefficient.Results There were 134 DRGs groups in the normal group(96.36%)and 17 DRGs groups in the abnormal group(3.64%).Univariate analysis showed that the length of stay,whether to stay in ICU,and the amount of profit and loss had statistical significance,P<0.05.According to multiple regression analysis,the length of stay in ICU was the influential factor of the norm deviation coefficient,P<0.05,and the total drug cost in the normal group was 1,251.65 yuan lower than that in the abnormal group,27911.82 yuan.The total consumables of 8310.77 yuan was higher than that of non-normal group(4403.45 yuan),and the difference was statistically significant(P<0.05).Conclusions Hospital stay and ICU stay were the main causes of abnormal norm deviation coefficient in DRGs settlement.Hospitals should standardize diagnosis and treatment,and apply clinical pathways to shorten hospital stay.At the same time,when applying DRGs,it was necessary to adjust the weight of groups for patients in intensive care medicine,so as to group them more scientifically and rationally.

关 键 词：定额偏离系数 DRGS 资金监管 原因分析 

分 类 号：R197.323[医药卫生—卫生事业管理]