消化道手术病例DRG再细分策略研究  

Strategies Study on DRG Subdivision of Gastrointestinal Surgery Cases

作　　者：余红星 赵欣如 王明举 李富星 田瑞 罗勤 张进 罗杰 Yu Hongxing;Zhao Xinru;Wang Mingju(Taihe Hospital of Shiyan City/Affiliated Hospital of Hubei University of Medicine,Shiyan,Hubei,442000,China;不详)

机构地区：[1]十堰市太和医院·湖北医药学院附属医院,湖北十堰442000 [2]湖北医药学院公共卫生与健康学院,湖北十堰442000

出　　处：《中国医院管理》2025年第5期92-96,共5页Chinese Hospital Management

基　　金：国家卫生健康委医院管理研究所“公立医院精细化管理与评价研究项目”(N1HA23JXH079);湖北省教育厅哲学社会科学研究项目(23Y150)。

摘　　要：目的探讨消化道手术病例DRG再细分策略,为提高DRG细分组区分度提供参考。方法选取湖北省某三级甲等医院、某三级医院2019年1月—2023年6月30日以及某二级医院2020—2021年的消化道手术病例共5108例。采用单因素分析、多重线性回归分析病例费用的影响因素,选取9名临床医师征求其对病例资源消耗影响因素的意见,按照病例费用呈现的峰值特点对病例再细分,将细分组与《按病组(DRG)付费分组方案(2.0版)》进行比较。结果GB1组、GB2组、GC1组和GC2组分别再细分为7、4、7和6个DRG组。各细分组组内病例费用变异系数降低,同质性增加,组间区分度增大;细分结果与《按病组(DRG)付费分组方案(2.0版)》调整思路基本一致但更细化。结论在DRG分组的基础上,按照病例费用峰值特点,可以对DRG组进行再细分。此细分策略能够为医保支付病例分组提供新思路。Objective To explore strategies for further subdivision of DRG in gastrointestinal surgery cases,providing references to enhance the differentiation of DRG subgroups.Methods A total of 5108 gastrointestinal surgery cases were selected from a tertiary grade A hospital and a tertiary hospital in Hubei Province,spanning from January 2019 to June 30,2023,and another secondary hospital’s data from 2020 and 2021.It employs single factor analysis and multiple linear regression analysis to identify factors influencing case costs.Additionally,the opinions of nine clinicans were gathered regarding factors affecting resource consumption in gastrointestinal surgery cases.The four selected case groups were further subdivided considers the peak characteristics of disease costs.It compares subdivided groups with the DRG Payment Subgroups Scheme(Version 2.0).Results Groups GB1,GB2,GC1,and GC2 were subdivided into 7,4,7,and 6 DRG groups,respectively.The coefficient of variation of each subdivided DRG were reduced,homogeneity was increased,and inter-group differentiation was increased.The results were consistent with the DRG Payment Subgroups Scheme(Version 2.0).Conclusion Based on DRG grouping,the DRG groups can be further subdivided according to the peak characteristics presented by case costs.This subdivision strategy is helpful to provide new ideas for case grouping of Medicare payment.

关 键 词：消化道手术 病例 疾病诊断相关分组 

分 类 号：R197.323.2[医药卫生—卫生事业管理]