DRG支付方式对肺癌住院患者医疗资源利用和医疗质量的影响  

Impact of DRG Payment on Medical Resource Utilization and Quality of Care for Hospitalized Lung Cancer Patients

作　　者：胡筱玙 吕静静[3,4] 崔永春 HU Xiaoyu;LYU Jingjing;CUI Yongchun(Department of Public Health,Shandong Cancer Prevention and Control Institute(Shandong Cancer Hospital),Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 250117,China;School of Public Health,Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 250117,China;Expanded Program Immunization Division of Shandong Provincial Center for Disease Control and Prevention,Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention,Jinan 250014,China;School of Public Health,Shandong University Cheeloo College of Medicine,Jinan 250011,China)

机构地区：[1]山东省肿瘤防治研究院(山东省肿瘤医院)公共卫生教研室,山东第一医科大学(山东省医学科学院),济南250117 [2]山东第一医科大学(山东省医学科学院)公共卫生与健康管理学院,济南250117 [3]山东省疾病预防控制中心山东省传染病预防控制重点实验室,济南250014 [4]山东大学齐鲁医学院公共卫生学院,济南250011

出　　处：《协和医学杂志》2024年第5期1059-1068,共10页Medical Journal of Peking Union Medical College Hospital

基　　金：国家卫生健康委医院管理研究所“医疗质量(循证)管理研究项目”(YLZLXZ23G016)。

摘　　要：目的分析疾病诊断相关分组(diagnosis related group,DRG)支付方式对肺癌住院患者医疗资源利用和医疗质量的影响,为我国医保支付方式改革和医疗效率及质量提升提供参考。方法回顾性分析2021年1月28日—2024年4月16日就诊于山东省某三级甲等肿瘤医院肺恶性肿瘤患者的病案首页信息,采用自身配对设计,以2021年10月26日为干预点,收集同一患者在DRG实施前(2021年1月28日—2021年10月25日)和DRG实施后(2021年10月26日—2024年4月16日)的病案首页信息,并通过间断时间序列回归模型分析DRG实施前后医疗资源利用指标(包括住院天数、住院费用、报销费用、自付费用、放化疗次数、靶向及免疫治疗次数、护理检查次数)和医疗质量指标[包括严重并发症或合并症(major complication or comorbidity,MCC)、并发症或合并症(complication or comorbidity,CC)发生次数、30 d再入院次数]的变化。结果共纳入944例患者,其中男性占比49.4%,女性占比50.6%;65岁以下患者占比67.1%,65岁及以上患者占比32.9%。DRG实施后住院天数(β_(2)=-3.235,P<0.001)、住院费用(β_(2)=-5155.900,P<0.001)、报销费用(β_(2)=-2120.350,P=0.020)、自付费用(β_(2)=-3035.555,P<0.001)均显著减少;放化疗次数、靶向免疫治疗次数、护理检查次数均无明显变化(P均>0.05);MCC/CC发生次数显著增加(β_(2)=3.011,P<0.001);30 d再入院次数无显著变化(P>0.05)。结论DRG支付方式可有效控制医疗费用和住院时间,提高医院管理效率,但可能增加MCC/CC,影响医疗质量,需关注DRG改革对医疗质量的潜在影响。Objective To evaluate the impact of diagnosis⁃related group(DRG)payment reform on medical resource utilization and healthcare quality among hospitalized lung cancer patients,so as to provide critical insights into China's healthcare payment reform and enhance medical efficiency and quality.Methods A retrospective analysis was conducted using medical records from a tertiary oncology hospital in Shandong province,with a focus on patients diagnosed with malignant lung tumors between January 28,2021 and April 16,2024.A self⁃paired design was implemented,with October 26,2021 serving as the intervention point.Data from the same patients were collected for two periods:pre⁃DRG payment(January 28,2021⁃October 25,2021)and post⁃DRG payment(October 26,2021⁃April 16,2024).An interrupted time series(ITS)regression model was employed to compare the changes in medical resource utilization indicators(e.g.,length of stay,total hospital expenses,reimbursement expenses,out⁃of⁃pocket expenses,number of chemotherapy/radiotherapy sessions,number of targeted/immunotherapy sessions,and number of nursing examinations)and healthcare quality indicators,including the incidence of major complications or comorbidities(MCC),complications or comorbidities(CC),and 30⁃day readmission rates.Results A total of 944 patients were included in the analysis,with 49.4%male and 50.6%female;67.1%were under 65 years of age,while 32.9%were 65 years or older.After the DRG payment,there was a significant reduction in length of stay(β_(2)=-3.235,P<0.001),total hospital expenses(β_(2)=-5155.900,P<0.001),reimbursement expenses(β_(2)=-2120.350,P=0.020),and out⁃of⁃pocket expenses(β_(2)=-3035.555,P<0.001).However,the number of chemotherapy/radiotherapy sessions,targeted/immunotherapy sessions,and nursing examinations did not exhibit significant changes.The incidence of MCC/CC significantly increased(β_(2)=3.011,P<0.001),whereas the 30⁃day readmission rate remained unchanged.Conclusions The DRG payment reform effectively reduces medical co

关 键 词：肺癌 医疗质量 医疗资源利用 DRG 

分 类 号：R734.2[医药卫生—肿瘤] R197.323[医药卫生—临床医学]