基于CHS-DRG的儿童专科医院骨科病例模拟运行现状与优化策略研究  

Study on the Existing State and Optimization Approach for Executing Orthopedic Case Simulation in a Pediatric Specialty Hospital Using CHS-DRG

作　　者：郭晓雁 高广颖 徐宁 张念英 张娜 尤楚迪 田佳帅 Guo Xiaoyan;Gao Guangying;Xu Ning;Tian Jiashuai(Children's Hospital,Capital Institute of Pediatrics,Beijing,100020,China;不详)

机构地区：[1]首都儿科研究所附属儿童医院,北京100020 [2]首都医科大学公共卫生学院,北京100069

出　　处：《中国卫生经济》2024年第11期21-26,共6页Chinese Health Economics

基　　金：北京市医院管理中心2020年度“培育计划”项目(PG2020027)。

摘　　要：目的:通过深入分析首都儿科研究所附属儿童医院骨科DRG模拟运行情况,为医院骨科实际付费的成本控制和专科发展提供指导。方法:以首都儿科研究所附属儿童医院骨科病房736名患者为研究对象,运用四象限分析法详细研究各病组的盈亏状况。采用logistic回归分析影响盈亏的关键因素。结果:骨科患儿以损伤及先天性疾病为主。通过波士顿矩阵分析,确定了优势病组(2组,占4.8%)、劣势病组(15组,占35.7%)、重点病组(8组,占19.0%)和潜力病组(17组,占40.5%),其中优势病组(IF19、IH15)占盈利组总收益的67.7%,是关键病组。无论病组是否盈亏,耗材费占比均高达43%~45%。logistic回归分析结果显示年龄、耗材费占比、检查费占比、手术费占比和其他费用占比对医院是否盈利有显著影响,耗材费占比为最大的负向预测因素(β=-2.238)。结论:医院需通过耗材精细化管理、四象限分析法的运用、加强成本核算、差异化资源分配等手段,优化费用结构,提高盈利概率。Objective:To guide cost control and the development of orthopedic specialty services in actual payment by thoroughly analyzing the functioning of DRG simulation in the pediatric orthopedic department of the Capital Institute of Pediatrics.Methods:A total of 736 patients from the orthopedic ward of the Capital Institute of Pediatrics were included as study subjects.The four-quadrant grouping method was employed to examine the profitability status of each diagnosis group in detail.A logistic regression model explored the key factors influencing profitability.Results:Congenital illnesses and traumas account for most pediatric orthopedic cases.Benefit groups(2 groups,4.8%),disadvantageous groups(15 groups,35.7%),key groups(8 groups,19.0%),and potential groups(17 groups,40.5%)are found using the Boston Matrix analysis.The profit group depends on the benefit groups(IF19,IH15)for 67.7%of its total revenue.No matter how profitable they are,medical consumables comprise a sizable portion(43%-45%).According to regression analysis,hospital profitability is highly impacted by age,consumable ratio,examination cost ratio,surgery cost ratio,and other cost ratios(P<0.05).The consumable ratio is the most significant negative predictor(β=-2.238).Conclusion:Hospitals need to optimize their cost structure and increase the probability of profitability through refined management of consumables,the four-quadrant analysis method,strengthened cost accounting,and differentiated resource allocation.

关 键 词：国家医疗保障疾病诊断相关分组 儿童 骨科 模拟运行 优化策略 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.684[经济管理—保险]