某院药品消耗指数与DRG超支的相关性及阈值效应分析  

Analysis of the correlation of drug consumption index with DRG overspending and its threshold effect in a hospital

作　　者：杨香瑜[1] 李璐璐[1] 余子珩 张韶辉[1] YANG Xiangyu;LI Lulu;YU Ziheng;ZHANG Shaohui(Dept.of Pharmacy,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院药学部,武汉430022

出　　处：《中国药房》2025年第1期113-116,共4页China Pharmacy

基　　金：武汉药学会科研基金项目(No.WHPA202302088)。

摘　　要：目的探讨药品消耗指数与疾病诊断相关分组(DRG)超支的相关性,为医院优化费用结构、加强精细化管理提供依据。方法以某三级甲等医院2023年9-11月DRG入组病例为研究资料,分别采用Logistic回归模型、限制性立方样条(RCS)模型分析药品消耗指数与DRG超支的相关性以及阈值效应。同时基于药品消耗指数开展合理用药点评,进行精准控费及管理,并分析管控前(2023年1-6月)与管控后(2024年1-6月)全院主要药事指标变化情况。结果多因素Logistic回归分析结果显示,住院天数长、药品消耗指数高、转科、合并糖尿病是DRG超支的危险因素(P<0.05)。RCS模型结果表明,药品消耗指数与DRG超支呈非线性关系,当药品消耗指数≥0.64时,药品消耗指数与DRG超支风险呈正相关(P<0.05)。与管控前同期比较,管控后的次均医疗费用、次均药品费用、药品消耗指数均显著下降(P<0.01)。结论药品消耗指数是DRG超支的危险因素,其与DRG超支存在非线性关系和阈值效应。各医院可结合实际药品使用情况、疾病谱特征以及成本控制目标,综合考虑医疗质量、患者需求和医保支付能力等因素,设定合理的阈值并实施动态监测与干预,以实现药品使用的精准管控。OBJECTIVE To explore the correlation between drug consumption index and diagnosis related groups(DRG)overspending cases,and provide a basis for hospitals to optimize the cost structure and strengthen the refined management.METHODS Based on the data of DRG patients enrolled in a third-grade class A hospital from September to November 2023,the multivariate Logistic regression model and restricted cubic spline(RCS)model were used to analyze the correlation of drug consumption index with DRG overspending cases and its threshold effect,respectively.At the same time,rational drug use evaluation was conducted based on the drug consumption index,precise cost control and management were carried out,and the changes in the main pharmaceutical indicators of the whole hospital were analyzed before control(January-June 2023)and after control(January-June 2024).RESULTS The results of multivariate Logistic regression analysis showed that long hospitalization days,high drug consumption index,transfer to other departments and combined diabetes mellitus were the risk factors for DRG overspending(P<0.05).The results of the RCS model showed that the drug consumption index had a non-linear relationship with DRG overspending.When the drug consumption index was≥0.64,the drug consumption index was positively correlated with the risk of DRG overspending(P<0.05).Compared with the same period before the control,medical cost per time,drug cost per time and drug consumption index decreased significantly after the control(P<0.01).CONCLUSIONS The drug consumption index is a risk factor for DRG overruns,there is a non-linear relationship and threshold effect between it and DRG overruns.Each hospital can set a reasonable threshold and implement dynamic monitoring and intervention by comprehensively considering the actual drug usage,disease spectrum characteristics,and cost control targets,as well as factors such as medical quality,patient needs,and the payment capacity of medical insurance,which can effectively achieve precise control over drug

关 键 词：药品消耗指数 疾病诊断相关分组 LOGISTIC回归 限制性立方样条模型 阈值效应 

分 类 号：R95[医药卫生—药学]