胰腺大手术资源消耗分析及DRG支付方案改进意见  

Analysis of resource consumption in major pancreatic surgery and improvement of DRG payment scheme

作　　者：侯睿[1] 刘晓坤 谭旭彤 张太平[1] 朱卫国 王维斌[1] HOU Rui;LIU Xiaokun;TAN Xutong;ZHANG Taiping;ZHU Weiguo;WANG Weibin(Department of General Surgery,Chinese Academy of Medical Sciences Peking Union Medical College Hospital,Beijing100730,China;Department of Medical Insurance,Chinese Academy of Medical Sciences Peking Union Medical College Hospital,Beijing100730,China;Department of Medical Affairs,Chinese Academy of Medical Sciences Peking Union Medical College Hospital,Beijing100730,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730 [2]中国医学科学院北京协和医院医疗保险管理处,北京100730 [3]中国医学科学院北京协和医院医务处,北京100730

出　　处：《中国医药导报》2024年第28期175-180,共6页China Medical Herald

摘　　要：目的分析疾病诊断相关分组(DRG)HB13(胰、肝切除和/或分流手术,伴一般并发症或合并症)内胰腺手术患者的住院费用,探索组内费用一致性,明确对费用具有显著影响的临床因素,并提出分组改进意见。方法收集2022年3月15日至2023年12月31日中国医学科学院北京协和医院基本外科收治、经DRG结算的医保患者,以变异系数(CV)描述HB13组的费用一致性;结合临床经验及专家意见,以多元线性回归分析住院费用的影响因素,以及该因素对各分项费用的影响。对HB13提出细分建议,以t检验及CV验证。结果HB13组CV为0.4。行机器人手术、行胰十二指肠切除术是住院费用的显著影响因素。行机器人手术的患者总费用平均增加42264元,该增加主要来源于手术费;行胰十二指肠切除术患者的总费用平均增加37441元,各分项费用均显著增加。将HB13依据是否行胰十二指肠切除术细分,各亚组的CV均显著下降。结论HB13费用一致性较科室其他DRG组更低。建议将机器人手术患者进行除外支付或额外补充支付,以鼓励该新技术在临床的广泛开展;建议将行胰十二指肠切除术的患者单独成组。建议根据不同病种的平均住院费用,设立阶梯式的CV值作为DRG组细分标准,以达到更高的组内费用一致性,节约医保资金,同时避免出现医疗紧缩、挑拣患者等不良后果。Objective To investigate the cost homogeneity of the diagnosis related groups(DRG)group HB13(major operation of pancreas or liver,with general complications or comorbidities),to explore the cost consistency within the group,identify the clinical factors that have a significant impact on the cost,and to propose suggestions for group improvement.Methods Medicare patients admitted to the Department of Basic Surgery of Peking Union Medical Union Hospital of Chinese Academy of Medical Sciences from March 15,2022 to December 31,2023 who were cleared by DRG were collected,coefficient of variation(CV)was used to describe the cost consistency of HB13 group.Combined with clinical experience and expert opinions,multiple linear regression was used to analyze the influencing factors of hospitalization expenses and the influence of these factors on each item of expenses.The subdivision of HB13 was proposed and verified by t test and CV.Results The CV of HB13 group was 0.4.Robotic assisted surgery,pancreaticoduodenectomy were two independent factors that significantly influence the hospitalization cost.The cost of the patients with robotic assisted surgery was increased 42264 yuan,and the increase mainly comes from the operation fee.The cost of the patients with pancreaticoduodenectomy was increased 37441 yuan,and the increase come from all categories of the cost.HB13 was subdivided according to whether pancreaticoduodenectomy was performed,CV of all subgroups decreased significantly.Conclusion The group HB13 has a relatively low cost homogeneity.It is recommended to set a separate payment or supplementary payment for patient with robotic assisted surgery,so as to promote its clinical utilization.And a separte group should be established for the patients receive pancreaticoduodenectomy.It is recommended to set stepwise CV criteria in line with the average cost of different DRG groups,in order to have a higher cost homogeneity,to lower medical expenses as well as various negative effects such as cutting services,reducing quality

关 键 词：疾病诊断相关分组 胰腺手术 胰十二指肠切除术 机器人手术 变异系数 

分 类 号：R657.5[医药卫生—外科学] R197[医药卫生—临床医学]