公立医院DRG临床路径管控方案探索及效果评价  

Exploration and Effect Evaluation of DRG-based Clinical Pathway Control Program in Public Hospitals

作　　者：王玉廷[1] 阳文琳[1] WANG Yuting;YANG Wenlin(The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;不详)

机构地区：[1]重庆医科大学附属第二医院,重庆400010

出　　处：《卫生经济研究》2024年第7期71-75,共5页

基　　金：重庆市2020年科卫联合医学科研项目“基于DRGs的住院医疗成本管理及控制的研究”(2020MSXM114);重庆市2022年卫生健康委科研项目“基于细化DRG病种的临床路径管理方案的制定及实施的研究”(2022WSJK09);重庆市2023年卫生健康委科研项目“基于公立医院高质量发展及DRG支付下融合DIP的临床路径管控方案的研究”(2023WSJK005)。

摘　　要：目的:探索基于DRG的临床路径管理方案,评价其实施效果。方法:选取重庆市医保局本土化DRG分组后的数据进行分析,采用Wilcoxon秩和检验对比评估临床路径效果。结果:实行基于DRG的临床路径管控后,不同分组的患者住院费用有效降低,且差异具有统计学意义;DRG组层面,相比非路径组,RE13、RW19、CB19等路径组住院费用均降低且具有统计学意义;同一DRG组的检查费、药品费、耗材费、治疗费及其他费用均有效降低,且差异均有统计学意义。结论:基于DRG的临床路径管理可以通过有效降低具体病种费用,最终达到控制医疗支出、节约医保基金的目的。Objective To explore the DRG-based clinical path control program,and to evaluate its implementation effect.Methods The data after the localized DRG grouping of Chongqing Municipal Healthcare Security Administration were selected for analysis,and the Wilcoxon rank sum test was used to compare and evaluate the effect of clinical pathways.Results After the implementation of DRG-based clinical pathway control,the hospitalization costs of patients in different subgroups were effectively reduced,and the differences were statistically significant.At the level of DRG groups,compared with non-pathway groups,the hospitalization costs of pathway groups such as RE13,RW19,and CB19 were reduced,and the differences were statistically significant.The costs of examination,medicine,consumables,treatment,and other costs in the same DRG group were effectively reduced,and the differences were statistically significant.Conclusion DRG-based clinical pathway management can effectively reduce the costs of specific diseases,and ultimately achieve the purpose of controlling medical expenditures and saving health insurance funds.

关 键 词：疾病诊断相关分组 临床路径 效果评价 

分 类 号：F840.684[经济管理—保险]