基于CHS-DRG分组的子宫肌瘤患者住院费用分析  

Analysis on the Hospitalization Expenses of Patients with Hysteromyoma Based on CHS-DRG Grouping

作　　者：李音[1] 冯迟[1] Li Yin;Feng Chi(Department of Medical Insurance,Beijing Maternity Hospital Affiliated to Capital Medical University/Beijing Maternal and Child Health Hospital,Beijing 100026,China;不详)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院医疗保险办公室,北京市100026

出　　处：《中国病案》2024年第10期78-82,共5页Chinese Medical Record

摘　　要：目的分析子宫肌瘤疾病CHS-DRG分组情况、住院费用影响因素,为合理控制费用增长、探索CHS-DRG付费发展提供参考。方法筛选某医院2022年3月15日-2022年9月15日共计698例子宫肌瘤住院患者的病案和结算数据,采用描述性统计分析CHS-DRG入组情况、补偿情况和住院费用结构、采用变异系数(CV值)衡量组内同质性,采用单因素分析及多元线性回归分析住院费用影响因素。结果子宫肌瘤例均住院费用为16837.67元,手术、耗材和药品共占据总费用的77%。在CHS-DRG结算中共入6组,变异系数均小于0.6,ND19、NE19、NF19组呈亏损状态。单因素分析发现,患者年龄(P=0.005)、住院天数(P=0.000)、手术方式(P=0.000)、手术个数(P=0.000)、肌瘤部位(P=0.000)、CHS-DRG分组(P=0.000)影响住院费用,差异有统计学意义。多元线性回归进一步得出,住院天数(β=0.268,P=0.000)、手术个数(β=0.297,P=0.000)、手术方式是住院费用的主要影响因素。住院费用随手术个数和住院天数的增加而增加,每增加1个住院日,住院费用提升826.321元;手术个数每增加1个,住院费用提升1000.540元。腹腔镜组、开腹组、子宫动脉栓塞术组费用显著高于宫腔镜组,分别为7492.26元(β=0.583,P=0.000)、8040.71元(β=0.455,P=0.000)和14985.55元(β=0.208,P=0.000)。结论子宫肌瘤疾病CHS-DRG分组较为合理,但仍存在补偿不足情况。住院天数、手术个数和手术方式主要影响住院费用,医院应加强临床路径管理、建立病种诊疗规范、缩短住院时间;推进病种成本管理,优化费用结构、压缩费用空间;通过DRG分组规则、病案质量培训等措施,提高入组准确率,在实践中探索更适宜临床病例的CHS-DRG分组方案。Objectives To analyze the grouping of uterine fibroid disease CHS-DRG and the influencing factors of hospitalization expenses,providing reference for reasonable cost control and exploring the development of CHS-DRG payment.Methods Screening the medical records and settlement data of 698 hospitalized patients with uterine fibroids from March 15th to September 15th,2022,using descriptive statistical analysis of CHS-DRG enrollment,compensation,and hospitalization expense structure,coefficient of variation(CV)to measure homogeneity within the group,and single factor analysis and multiple linear regression to analyze factors affecting hospitalization expenses.Results The average hospitalization expense for cases of uterine fibroids was 16837.67yuan,with surgery,consumables,and medication accounting for 77%of the total cost.Six groups were included in the CHS-DRG settlement,with coefficients of variation all less than 0.6.The ND19,NE19,and NF19 groups were in a loss state.Univariate analysis found that patient age(P=0.005),length of hospitalization stay(P=0.000),surgical method(P=0.000),number of surgeries(P=0.000),location of fibroids(P=0.000),and CHS-DRG grouping(P=0.000)had a statistically significant impact on hospitalization costs.Further analysis using multiple linear regression showed that the length of hospital stay(β=0.268,P=0.000),number of surgeries(β=0.297,P=0.000)and surgical method are the main influencing factors of hospitalization costs.The hospitalization cost increases with the number of surgeries and length of stay.For each additional length of stay,the hospitalization cost increases by 826.321 yuan;For every increase in the number of surgeries,the hospitalization cost increases by 1000.540 yuan.The cost of laparoscopic group,open group,and uterine artery embolization group was significantly higher than that of hysteroscopy group,with a total cost of 7492.26 yuan,respectively(β=0.583,P=0.000),8040.71 yuan(β=0.455,P=0.000)and 14985.55 yuan(β=0.208,P=0.000).Conclusions The CHS-DRG grouping for ute

关 键 词：CHS-DRG付费 子宫肌瘤 住院费用 

分 类 号：R737.33[医药卫生—肿瘤] R197.3[医药卫生—临床医学]