DRGs支付方式下某三级甲等医院预住院模式成效分析  

Cost-effectiveness of the pre-hospitalization model in a tertiary hospital in the context of diagnosis-related groups(DRGs)payment system

作　　者：华小果 胡蕊 冯夕秋[1] 赵晨晨[1] 吴雪枫 马元新 孙谦 Hua Xiaoguo;Hu Rui;Feng Xiqiu;Zhao Chenchen;Wu Xuefeng;Ma Yuanxin;Sun Qian(The Second Affiliated Hospital of Anhui Medical University;the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230601,Anhui Province,China)

机构地区：[1]安徽医科大学第二附属医院,合肥230601 [2]安徽中医药大学第一附属医院

出　　处：《中国医疗管理科学》2024年第5期37-42,共6页Chinese Journal Of Medical Management Sciences

基　　金：2022年安徽医科大学校科研基金(2022xkj316)。

摘　　要：目的利用DRGs综合绩效评价指标对某三级甲等医院预住院模式的成效进行评价,为预住院模式在控费体系下进一步发展提供参考依据。方法选取2022年1月1日至2023年6月30日于该院办理预住院登记并成功入院的237例患者相关数据,并纳入同期普通入院的19323例患者数据,两组患者的住院费用、住院天数差异采用曼-惠特尼秩和检验(Mann-Whitney U型检验),盈余占比差异采用卡方检验比较。采用熵值TOPSIS法对预住院管理模式的DRGs综合绩效进行评价。结果预住院患者的住院日、材料费、检查费、化验费低于普通入院患者,差异具有统计学意义(P<0.05);盈余占比差异无统计学意义(P>0.05)。综合绩效评价排名依次是普外科、肿瘤科、核医学科、血液内科、眼科。结论预住院模式可有效降低患者材料费、检查费、化验费和住院时间,促进医院DRGs运营收支平衡;各科室可以根据自身情况选择收治方式和发展预住院优势病种。Objective To assess the cost-effectiveness of the pre-hospitalization model at a tertiary hospital using the comprehensive performance evaluation index of Diagnosis-Related Groups(DRGs),aiming to provide evidence for the advancement of the pre-hospitalization model under a cost containment framework.Methods Patient data for those who completed pre-hospitalization registration and were subsequently admitted to the hospital between January 1,2022,and June 30,2023,were extracted.The Mann-Whitney U test was performed to compare differences in hospitalization costs and length of stay between the two groups.Additionally,the Chi-square test was utilized to assess variations in the proportions of surplus outcomes.The entropy-based TOPSIS method was applied to evaluate the comprehensive performance of DRGs in the pre-hospitalization model.Results The duration of hospitalization,material costs,examination fees,and laboratory test fees in pre-hospitalized patients were found to be significantly lower than those for the general admitted patients(all P<0.05),while the difference in the proportion of surplus outcomes showed no statistical significance(P>0.05).The department of general surgery had the highest comprehensive performance,followed by the departments of oncology,nuclear medicine,hematology,and ophthalmology.Conclusion The pre-hospitalization model is effective in diminishing costs associated with materials,examinations,laboratory tests,and hospital stays,thereby facilitating the income-expenditure balance of the DRGs.Departments may select their own admission methodology and cultivate pre-hospitalization priority diseases based on their specific circumstances.

关 键 词：预住院 疾病诊断相关分组 成效评价 熵值TOPSIS法 

分 类 号：R197[医药卫生—卫生事业管理]