基于DRG的抗菌药物使用合理性评价细则构建及多部门协作管控成效  

Effectiveness of multi-department collaboration control based on rationality evaluation rule for antibiotics use under DRG

作　　者：邱昌露 毕红朋 代雪飞 QIU Changlu;BI Hongpeng;DAI Xuefei(Dept.of Pharmacy,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China;Dept.of Pharmacy,Anhui Public Health Clinical Center,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院药学部,合肥230032 [2]安徽省公共卫生临床中心药学部,合肥230032

出　　处：《中国药房》2024年第23期2941-2947,共7页China Pharmacy

基　　金：安徽省科研编制计划项目(No.2022AH050641);安徽医科大学校科研基金项目(No.2023xkj303)。

摘　　要：目的以呼吸系统感染/炎症的疾病诊断相关分组(DRG)为抓手,促进抗菌药物的合理使用。方法创建呼吸系统感染/炎症患者抗菌药物临床使用合理性评价细则(包括药物选择、集采品种、用法用量等12项评价指标),并运用属性层次模型赋予各指标评分权重。采用加权优劣解距离(TOPSIS)法对2021年1-9月(多部门协作管控前,对照组)的102例及2022年1-9月(多部门协作管控后,干预组)的103例用药情况进行综合评价;计算各评价指标与最优方案的相对接近度,并比较多部门协作管控前后抗菌药物使用合理性、抗菌药物相关评估指标、卫生经济评估指标及诊疗结局相关指标的差异。结果在抗菌药物使用中,干预组患者抗菌药物总体使用不合理率、平均累计限定日剂量(DDD)及联合用药使用率均较对照组显著降低(P<0.05);在卫生经济评估指标中,干预组患者的次均抗菌药物费用及次均住院费用均较对照组显著降低(P<0.05);在诊疗结局相关指标中,干预组患者的平均住院天数较对照组显著减少(P<0.05),但两组间临床疗效并无明显差异(P>0.05)。进一步组间比较发现,在平均累计DDD上,对于ES31、ES33及ES35病组,干预组患者较对照组均显著降低(P<0.05);在联合用药使用率上,对于ES31、ES35病组,干预组患者较对照组均显著降低(P<0.05);在次均抗菌药物费用上,对于ES35病组,干预组患者较对照组显著降低(P<0.05),且干预组中ES35、ES33病组患者的次均抗菌药物费用均显著低于ES31病组(P<0.05)。结论基于DRG构建的呼吸系统感染/炎症患者抗菌药物临床使用合理性评价细则,可对抗菌药物使用合理性进行综合评价;多部门协作管控可提高抗菌药物使用合理性,降低医疗费用的支出。OBJECTIVE To promote rational use of antibiotics taking diagnosis related group(DRG)of respiratory system infection/inflammation as a starting point.METHODS The rules for evaluating the rationality of clinical use of antibiotics in patients with respiratory system infection/inflammation were established(including 12 evaluation indicators such as drug selection,centrally procured varieties,usage and dosage),and the attribute hierarchy model was applied to assign scoring weights to each indicator.A total of 102 cases from January to September 2021(before multi-department collaboration and control,as control group)and 103 cases from January to September 2022(after multi-department collaboration and control,as interention group)were comprehensively evaluated by weighted pros and cons method.The relative proximity(Ci)between each evaluation index and the optimal scheme was calculated,and the rationality of the use of antibacterial,antibacterial drug related index,health economic evaluation index and diagnosis and treatment outcome index were compared before and after multi-department collaboration control.RESULTS In the use of antibiotics,the irrational rate of antibiotics use,the average cumulative defined daily dose(DDD)and the utilization rate of combined drugs in the intervention group were significantly lower than control group(P<0.05).In the indicators of health economic evaluation,the average cost of antibiotics per time and average cost of hospitalization per time in the intervention group were significantly lower than control group(P<0.05).In the relevant indicators of diagnosis and treatment outcome,the average hospitalization days of patients in the intervention group were significantly lower than control group(P<0.05),but the clinical efficacy was not significantly different(P>0.05).Further comparison between groups showed that the average cumulative DDD of ES31,ES33 and ES35 patients in the intervention group was significantly lower than control group(P<0.05).The utilization rate of combined drugs in ES31

关 键 词：疾病诊断相关分组 多部门协作管控 加权TOPSIS法 呼吸系统感染/炎症 抗菌药物 合理性评价 

分 类 号：R969.3[医药卫生—药理学] R978.1[医药卫生—药学]