DRG付费模式下颅内出血住院费用影响因素的研究  

A Study of Effect Factors of Hospitalization Expense with Intracranial Hemorrhage Under DRGs Payment Model

作　　者：余沛林 陈博年[1] 崔宇菁 魏可帅 伊越 马帅 YU Peilin;CHEN Bonian;CUI Yujing;WEI Keshuai;YI Yue;MA Shuai(Medical Insurance Department of Tianjin Huanhu Hospital,Tianjin 300350,China;Medical Section of Tianjin Haihe Hospital,Tianjin 300350,China;Medical Record Management Section,Tianjin Medical University Eye Hospital/School of Optometry/Eye Institute/Tianjin Branch of National Clinical Research Center for Ocular Disease/Tianjin Key Laboratory of Retinal Functions and Diseases,Tianjin 300384,China;Department of Infectious,Tianjin Medical University Eye Hospital/School of Optometry/Eye Institute/Tianjin Branch of National Clinical Research Center for Ocular Disease/Tianjin Key Laboratory of Retinal Functions and Diseases,Tianjin 300384,China;Party Committee Office,Tianjin Center for Disease Control and Prevention,Tianjin 300011,China)

机构地区：[1]天津市环湖医院医保科,天津300350 [2]天津市海河医院医务科,天津300350 [3]天津医科大学眼科医院/眼视光学院/眼科研究所/国家眼耳鼻喉疾病临床医学研究中心天津市分中心/天津市视网膜功能与疾病重点实验室病案管理科,天津300384 [4]天津医科大学眼科医院/眼视光学院/眼科研究所/国家眼耳鼻喉疾病临床医学研究中心天津市分中心/天津市视网膜功能与疾病重点实验室感染科,天津300384 [5]天津市疾病预防控制中心党委办公室,天津300011

出　　处：《医学信息》2025年第3期54-60,共7页Journal of Medical Information

摘　　要：目的探索颅内出血性疾患DRG病组住院费用的影响因素,比较不同严重程度颅内出血患者住院费用影响因素的差异,为有效控制医疗费用增长,降低住院平均费用,减轻患者个人负担提供依据,以及医院DRG支付模式下的运营管理提供建议。方法以天津市某三甲医院为研究现场,选取2022年1月-12月共1608例颅内出血并采取保守治疗的出院患者,采用广义线性模型有序Logistic,根据DRG付费模式对颅内出血病例组分组,探析不同严重程度颅内出血患者住院总费用的影响因素差异。结果颅内出血各DRG组之间的总费用、药费占比、检查费占比、治疗费占比、手术费占比、床位费占比、医用材料费占比及其它费用占比比较,差异有统计学意义(P<0.05)。性别、住院时间、入院途径对住院费用具有显著影响,住院费用与住院时间正相关,急诊入院患者的住院费用更高(P<0.05)。结论医院应积极调整住院费用结构,通过优先使用医保目录内药品等方式控制药品费的支出,积极开展日间病房模式,降低患者住院时间与费用。Objective To explore the influencing factors of hospitalization expenses in DRG disease group of intracranial hemorrhagic diseases,and to compare the differences of influencing factors of hospitalization expenses in patients with different severity of intracranial hemorrhage,so as to provide basis for effectively controlling the increase of medical expenses,reducing the average hospitalization expenses,reducing the personal burden of patients,and providing suggestions for the operation and management of hospital DRG payment mode.Methods Taking a tertiary hospital in Tianjin as the research site,a total of 1608 discharged patients with intracranial hemorrhage and conservative treatment from January to December 2022 were selected.Generalized linear model ordered logistic was used to analyze the influencing factors of total hospitalization expenses of patients with different severity of intracranial hemorrhage according to DRG payment mode.Results There were statistically significant differences in the total cost,proportion of drug cost,proportion of examination cost,proportion of treatment cost,proportion of operation cost,proportion of bed cost,proportion of medical material cost and proportion of other cost among DRG groups of intracranial hemorrhage(P<0.05).Gender,length of stay,and admission route had significant effects on hospitalization expenses.Hospitalization expenses were positively correlated with length of stay,and hospitalization expenses of emergency patients were higher(P<0.05).Conclusion Hospitals should actively adjust the structure of hospitalization expenses,control the expenditure of drug costs by giving priority to the use of drugs in the medical insurance catalogue,and actively carry out the day ward model to reduce the hospitalization time and cost of patients.

关 键 词：DRG 住院费用 颅内出血性疾患 医保 日间病房 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R197.3[医药卫生—临床医学]