DRG支付背景下重庆市公立三级医院FM19病组超支的影响因素研究  

Study on influencing factors of overspending cases in FM19 disease group in public tertiary hospitals in Chongqing under the background of DRG payment

作　　者：甘岚澜 伍渊麟 向贵圆 陈世耕 刘耀 GAN Lanlan;WU Yuanlin;XIANG Guiyuan;CHEN Shigeng;LIU Yao(Department of Pharmacy,Daping Hospital,Army Medical University,Chongqing 400042,China;Medical Insurance Office,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院药剂科,重庆400042 [2]陆军军医大学大坪医院医保办,重庆400042

出　　处：《卫生软科学》2025年第3期1-5,共5页Soft Science of Health

基　　金：国家卫生健康委医药卫生科技发展研究中心临床研究科研专项(WKZX2023CX210006);重庆市临床药学重点专科建设项目;重庆市中青年医学高端人才。

摘　　要：[目的]分析探讨重庆市公立三级医院FM19病组超支病例的影响因素,为医疗机构及相关部门加强超支病例管控提供思路。[方法]收集重庆市公立三级医院2022年1月1日-2023年3月31日FM19病组按DRG结算的6747例患者相关数据,采用描述性统计分析、单因素分析、多因素Logistic回归分析及关联规则分析法,分析影响DRG结算病例超支的因素。[结果]疾病因素(疾病类型、PCI既往史)、社会经济学因素(医保类型、住院天数、支架数量、治疗血管数量、是否合并其他操作)均为DRG结算病例超支的显著影响因素(P<0.05)。进一步关联规则分析显示,患者具有多个社会经济学因素时发生DRG结算病例超支的可能性最大。[结论]医疗机构应重点关注符合强关联规则条件的患者,通过规范诊疗流程,加强介入手术路径管理;建立内部审核机制,及时调整和完善临床路径,以及加强与医疗保障部门的沟通,及时反馈结算问题。在实现对医疗费用有效管控的同时,推动医疗机构的高质量发展和医保体系的良性运行。Objective To analyze and discuss the influencing factors of overspending cases in FM19 disease group in public tertiary hospitals in Chongqing,and to provide ideas for medical institutions and relevant departments to strengthen the control of overspending cases.Methods The relevant data of 6747 patients in FM19 disease group with DRG settlement in public tertiary hospitals in Chongqing were collected from January 1,2022 to March 31,2023.Descriptive statistical analysis,single factor analysis,multiple logistic regression analysis and association rules analysis were used to analyze the factors affecting the overspending of DRG cases.Results Disease factors(types of diseases,previous medical history of percutaneous coronary intervention)and socioeconomic factors(types of medical insurance,hospital length of stay,the number of stents,the number of treated vessels,and whether other procedures were combined)were significant influencing factors of overspending cases with DRG settlement(P<0.05).Further association rules analysis showed that overspending cases with DRG settlement were most likely to occur when patients had multiple socioeconomic factors.Conclusions Medical institutions should focus on patients who meet the conditions of strong association rules,strengthen the management of interventional surgery path planning by standardizing the diagnosis and treatment process,establish an internal review mechanism to adjust and improve clinical pathways in time,and strengthen the communication with the healthcare security department to give timely feedback on settlement problems.It is necessary to effectively control medical costs and promote the high-quality development of medical institutions and the sound operation of the healthcare security system.

关 键 词：DRG FM19病组 超支 影响因素分析 关联规则分析 

分 类 号：R197[医药卫生—卫生事业管理] R194[医药卫生—公共卫生与预防医学]