基于DRG付费管理的骨创伤患者手术部位感染直接经济负担评价  

Direct economic burden of surgical site infection in orthopaedic trauma patients based on DRG payment management

作　　者：陈音汁 马会旭 周明川 叶和梅 成燕[1] 刘四云 CHEN Yin-zhi;MA Hui-xu;ZHOU Ming-chuan;YE He-mei;CHENG Yan;LIU Si-yun(Department of Healthcare-associated Infection Control,Chongqing General Hospital,Chongqing University,Chongqing 401147,China;Department of Orthopaedic Trauma,Chongqing General Hospital,Chongqing University,Chongqing 401147,China;Department of Medical Record Management,Chongqing General Hospital,Chongqing University,Chongqing 401147,China)

机构地区：[1]重庆大学附属人民医院重庆市人民医院医院感染控制处,重庆401147 [2]重庆大学附属人民医院重庆市人民医院关节骨科,重庆401147 [3]重庆大学附属人民医院重庆市人民医院病案管理科,重庆401147

出　　处：《中国感染控制杂志》2024年第7期868-873,共6页Chinese Journal of Infection Control

基　　金：重庆市自然科学基金面上项目(cstc2021jcyi-msxmX0815)。

摘　　要：目的评价疾病诊断相关分组(DRG)付费管理方式下骨创伤患者发生手术部位感染(SSI)造成的直接经济负担。方法回顾性调查2022年5月1日—2023年5月30日某三级甲等医院骨创伤患者的临床资料,根据是否发生SSI进行分组,比较同一DRG细分组下发生SSI患者和非SSI患者的平均住院日数、平均住院费用等指标之间的差异,分析发生SSI造成的直接经济负担。结果研究共纳入435例按照DRG付费管理的手术患者,其中22例患者发生SSI,SSI发病率为5.06%;SSI组患者平均住院日数及平均住院费用均高于非SSI组患者,差异有统计学意义(P<0.05)。SSI患者的DRG细分组主要分布在IF45、IF15、IJ13、ZC13四组,其中IF45、IF15、ZC13组中SSI患者的平均住院时间明显增加(P<0.05),IJ13组中SSI患者平均住院费用明显增加(P<0.05)。结论在DRG付费管理方式下,骨创伤患者发生SSI明显增加患者直接经济负担,需不定期评估发现高风险DRG细分组患者,以期采取精准感控干预,降低SSI发病率。Objective To evaluate the direct economic burden caused by surgical site infection(SSI)in patients with orthopaedic trauma under the payment management of disease diagnosis-related groups(DRG).Methods Clinical data of patients with orthopaedic trauma in a tertiary first-class hospital from May 1,2022 to May 30,2023 were surveyed retrospectively.Patients were grouped based on whether SSI occurred.Differences in average length of hospital stay,average hospitalization expense,and other indicators between SSI patients and non-SSI patients in the same DRG subgroup were compared,and the direct economic burden caused by SSI was analyzed.Results A total of 435 patients who paid according to the DRG payment management were included in the study.Twenty-two patients had SSI,with an SSI incidence of 5.06%.Both the average length of hospital stay and average hospitalization expense of patients in the SSI group were higher than those in the non-SSI group,with statistically significant differences(P<0.05).The DRG subgroups of SSI patients were mainly four groups:IF45,IF15,IJ13,and ZC13.Among them,the average length of hospital stay of SSI patients in the IF45,IF15,and ZC13 groups increased significantly(P<0.05),and the average hospitalization expense of SSI patients in the IJ13 group increased significantly(P<0.05).Conclusion Under the DRG payment management,the direct economic burden of orthopaedic trauma patients with SSI increases significantly.It is necessary to periodically evaluate and identify high-risk DRG subgroup patients,so as to adopt precise infection control interventions and reduce SSI incidence.

关 键 词：疾病诊断相关分组 手术部位感染 骨创伤 医院感染 经济负担 DRG SSI 

分 类 号：R197.323.4[医药卫生—卫生事业管理]