基于国家疾病诊断相关分组分析新型冠状病毒感染后医院住院费用增长的影响因素  

The influence factor of the increase of hospital hospitalization expenses after the infection of novel coronavirus pneumonia were analyzed based on Chinese diagnosis related groups

作　　者：刘苑婷 黄国标 何丽萍[1] 方家尉 陈宇玲 LIU Yuanting;HUANG Guobiao;HE Liping;FANG Jiawei;CHEN Yuling(Department of Medical Affairs,The Affiliated Panyu Central Hospital of Guangzhou Medical University,Guangzhou,Guangdong,511400,China;Department of Financial,The Affiliated Panyu Central Hospital of Guangzhou Medical University,Guangzhou,Guangdong,511400,China)

机构地区：[1]广州医科大学附属番禺中心医院医务科,广东广州511400 [2]广州医科大学附属番禺中心医院财务科,广东广州511400

出　　处：《当代医学》2024年第24期88-92,共5页Contemporary Medicine

基　　金：广东省广州市卫生健康科技项目(20201A010086)。

摘　　要：目的探讨基于国家疾病诊断相关分组(Chinese diagnosis related groups,C-DRG)疫情时三级综合医院的住院费用变化的影响因素。方法收集广州医科大学附属番禺中心医院疫情前(2019年)和疫情时(2021年)住院患者的病案首页数据,以消化中心为例,基于C-DRG标准化各类住院费用,比较疫情前与疫情时DRG相关绩效指标、各类费用的构成、微创手术人次、四级手术人次、权重(relative weight,RW)≥1.5人次,采用多元线性回归分析各指标对住院费用的影响。结果疫情时住院费用为8125.9(5451.4,13774.6)元,高于疫情前的7509.3(4669.8,12770.0)元,差异有统计学意义(P<0.05)。疫情时,住院时间长于疫情前,微创手术占比高于疫情前,疑难重症患者(RW≥1.5)收治比例低于疫情前,差异有统计学意义(P<0.05);疫情前与疫情时四级手术比例及RW(CMI值是RW的均值)比较差异无统计学意义。多因素线性回归分析模型结果显示,住院时间延长、四级手术占比增高、微创手术占比增高、RW增大、疑难重症(RW≥1.5)患者收治占比增高是住院费用增加的主要影响因素(P<0.05)。疫情时,综合医疗服务费、诊断费、治疗费(含手术费)、耗材费高于疫情前,康复费低于疫情前,差异均有统计学意义(P<0.05);疫情前后西药费比较差异无统计学意义。各费用构成对住院费用增长影响较大的是耗材费、诊断费、综合医疗服务费和治疗费。应用DRG的思路进行分析,在收治相同DRG病种的基础上,疫情后的住院费用结构中诊断费、耗材费和治疗费(含手术费)较疫情前大幅增长,费用消耗指数均>2,分别为2.94、2.62和5.88。结论新冠病毒感染疫情时住院费用增加,主要外部原因是住院时间延长、四级手术和微创手术人数比例增加,主要内部因素是诊断费、耗材费和治疗费的增加。Objective To explore the influencing factors on the change of hospitalization expenses in third-level general hospitals afterthe infection of novel coronavirus pneumonia based on Chinese diagnosis related groups(C-DRG).Methods The information of inpatients'medical records before(2019)and after(2021)COVID-19 infection was selected.Different expense category were standardized and DRG indexes were calculated with the use of C-DRG.The influencing factors on hospitalization expenses after COVID-19 infection were analyzed,such as the index of DRG.Furthermore,multiple linear regression was used to analyze the influencing factors.Results During the epidemic,the hospitalization cost was 8125.9(5451.4,13774.6)yuan,which was higher than 7509.3(4669.8,12770.0)yuan before the epidemic,and the difference was statistically significant(P<0.05).During the epidemic,the hospitalization time was longer than before the epidemic,the proportion of minimally invasive surgery was higher than before the epidemic,and the proportion of difficult and severe patients(RW≥1.5)was lower than before the epidemic,the differences werestatistically significant(P<0.05);there was no significant difference in the proportion of grade 4 surgery and RW(CMI value is the mean value of RW)between before and during the epidemic.The results of multivariate linear regression analysis model showed that prolonged hospitalization time,increased proportion of grade 4 surgery,increased proportion of minimally invasive surgery,increased RW,and increased proportion of difficult and severe patients(RW≥1.5)were the main influencing factors of increasing hospitalization costs(P<0.05).During the epidemic,the comprehensive medical service fee,diagnosis fee,treatment fee(including operation fee)and consumables cost were higher than before the epidemic,and the rehabilitation cost was lower than before the epidemic,the differences werestatistically significant(P<0.05);there was no significant difference in the cost of western medicine before and after the epidemic.The mos

关 键 词：国家疾病诊断相关分组 住院费用 新型冠状病毒感染 费用构成 

分 类 号：R47[医药卫生—护理学]