四川省某三甲医院成人肺炎DRG分组效果评价与住院费用分析  

Evaluation of DRG Grouping Effectiveness and Analysis of Hospitalization Costs for Adult Pneumonia in a Tertiary Hospital in Sichuan Province

作　　者：崔欢欢 冯海欢[1] 杨华[1] 卢静[1] 李耘天 CUI Huanhuan(Office of Medical Insurance,West China Hospital of Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西医院医保办公室,四川成都610041

出　　处：《医学与社会》2024年第8期86-91,共6页Medicine and Society

基　　金：四川省科技厅重点研发项目,编号为2021YFS0145;四川省自然科学基金资助项目,编号为2023NSFSC1013;国家发改委重大工程项目,编号为2018gfgw0001。

摘　　要：目的:分析四川省某三甲医院成人肺炎按疾病诊断相关分组(DRG)的分组效果与住院费用情况,为优化DRG付费政策和单病种管理措施提供参考。方法:收集四川省某三甲医院2020-2021年成人肺炎患者的病案和费用数据,依据四川省DRG分组方案进行分组,采用变异系数(CV)和方差减少系数(RIV)评价4个DRG组的分组效果,运用秩和检验、多元逐步回归等方法分析患者住院费用的构成与影响因素。结果:该医院成人肺炎4个DRG组的CV值介于0.72-0.94,RIV值为0.51;各DRG组间住院费用差异均有统计学意义(P<0.05);药品费、化验费为住院费用的主要构成部分,占比分别为28.05%-46.60%、14.04%-30.56%;住院天数、合并症/并发症数量、有无手术操作等7个因素对住院费用有影响。结论:成人肺炎DRG组内一致性较好,组间异质性不足,费用结构需进一步优化,费用影响因素较为复杂;建议多种方式相结合优化DRG付费方案,建立多层次精细化费用管控体系,提高管理效能。Objective:To analyze the grouping effect of adult pneumonia according to disease diagnosis-related groups(DRG)and the status of hospitalization costs in a tertiary hospital in Sichuan Province,so as to provide a reference for optimizing DRG payment policies and single-disease management measures.Methods:The case data and cost data of adult pneumonia patients in a tertiary hospital in Sichuan Province from 2020 to 2021 were collected,and the grouping effect of the four DRG groups was evaluated by the coefficient of variation(CV)and the reduction in variance(RIV).The composition and influence of hospitalization costs of the patients were analyzed using the rank-sum test and multiple stepwise regression.Results:The CV value and RIV value of the four DRG groups of adult pneumonia ranged from 0.72 to 0.94,and the difference in hospitalization costs among the four DRG groups was statistically significant(P<0.05).Drug costs and laboratory testing fees were the main components of hospitalization costs,accounting for 28.05%-46.60%and 14.04%-30.56%,respectively.Seven factors,including the length of hospital stay,the number of comorbidities/complications,and the presence or absence of surgical procedures,affect the cost of hospitalization.Conclusion:The consistency of DRG groups in adults with pneumonia is good,the heterogeneity between groups is insufficient,the cost structure needs to be further optimized,and the cost influencing factors are complex.It is suggested to optimize the DRG payment scheme by combining multiple methods and to establish a multi-level refined cost control system to improve management efficiency.

关 键 词：疾病诊断相关分组 成人肺炎 分组效果 住院费用 

分 类 号：R-05[医药卫生]