DRG付费下脑缺血性疾病诊疗项目与临床路径匹配程度研究  

Study on the Mating Degree between Diagnosis and Treatment Items for Cerebral Ischemic Diseases and Clinical Pathways under DRG Payment

作　　者：代珊珊 高广颖 付映宏 田佳帅[1] 蔡心雨 焦卫平 王晓冬[4] Dai Shanshan;Gao Guangying;Fu Yinghong(School of Public Health,Capital Medical University,Beijing,100069,China;不详)

机构地区：[1]首都医科大学公共卫生学院,北京100069 [2]首都医科大学燕京医学院,北京101300 [3]首都医科大学宣武医院,北京100053 [4]佳木斯市医疗保障局,黑龙江佳木斯154002

出　　处：《中国医院管理》2025年第2期35-39,共5页Chinese Hospital Management

基　　金：首都卫生管理与政策研究基地开放性课题(2024JD02)。

摘　　要：目的 以脑缺血性疾病为例,探讨疾病诊断相关分组(DRG)付费下医生实际诊疗项目使用情况,分析实际诊疗项目与临床路径的匹配程度。方法 梳理脑缺血性疾病患者实际诊疗项目使用情况及费用占比,构建诊疗项目条目池;基于专家咨询法确定基本诊疗项目,与临床路径进行对比匹配。结果 脑缺血性疾病全部诊疗项目中仅21.27%的使用率达到10%以上,但费用占比达82.96%;42项诊疗项目被筛选为基本诊疗项目;化验检查项目与临床路径匹配程度高,但在药物治疗方面存在一定的差异。结论 脑缺血性疾病实际诊疗项目与临床路径存在一定的差异,且存在大量低使用率项目;部分高使用率项目并非基本诊疗项目,且多集中于化验检查项目中。建议DRG付费下增强临床路径关注度并定期进行更新优化,提升医生基于临床路径的诊疗意识,完善医生诊疗行为监管考核机制,定期更新优化临床路径,提高其可操作性。Objective Taking cerebral ischemic disease as an example, it explores the use of doctors' actual diagnosis and treatment items under DRG payment, and analyzes the matching degree between actual diagnosis and treatment items and clinical pathways. Methods Based on the actual diagnosis and treatment items for patients with cerebral ischemic diseases,it sorted out their usage and cost proportion,built a diagnosis and treatment item pool, determined the basic diagnosis and treatment items based on expert consultation, and compared and matched them with clinical pathways. Results Among all the diagnosis and treatment items of cerebral ischemic diseases,only 21.27% had a utilization rate of more than 10%,but the cost accounted for 82.96%. 42 diagnosis and treatment items were screened as basic diagnosis and treatment items. The degree of matching between laboratory inspection items and clinical pathways was high,but there were certain differences in drug treatment. Conclusion There are certain differences between actual diagnosis and treatment items and clinical pathways of cerebral ischemic diseases,and there are a large number of low-utilization items,some high-utilization items are not basic diagnosis and treatment items, and most of them are concentrated in laboratory inspection items. It is recommended to enhance the attention of clinical pathway under DRG payment and update and optimize it regularly,improve doctors' awareness of diagnosis and treatment based on clinical pathways,and improve the supervision and assessment mechanism of doctors' diagnosis and treatment behaviors,regularly update and optimize clinical pathways to improve their operability.

关 键 词：疾病诊断相关分组 脑缺血性疾病 诊疗项目 临床路径 

分 类 号：R197.323.2[医药卫生—卫生事业管理]