基于路径分析的视角验证慢性肾衰竭DRGs分组流程

Verification of DRGs packet flow in chronic renal failure with path analysis

目的:采用路径分析对慢性肾衰竭病住院费用各相关因素进行分析,以获取DRGs分组的主要影响因素,为复杂类型病种DRGs分组流程提供方法学上的借鉴和思路,为医保政策制定提供参考。方法:收集新疆某三级甲等综合医院2012年肾病科慢性肾衰竭病例及患者相关资料,应用路径分析对其住院费用影响因素进行分析,获得慢性肾衰竭DRGs分组流程主要影响因素。结果:慢性肾衰竭住院患者的医疗费用主要由治疗费、药费、检查费用构成,影响因素主要包括住院天数、透析方式、是否ICU、附加诊断个数、并发症、年龄分组等。结论:为达到医、患、保三方认同的住院费用支付方式的适宜路径,DRGs分组流程应结合本地区、本医院的数据加以分析后,确定分组因素,有目的的进行费用控制。同时DRGs—PPS可以尝试使用路径分析对实际的病种及费用进行分析后再进行DRGs分组。

Objective：In order to provide reference for healthcare sector policy formulation and a methodological reference to control complicated medical fees,path analysis has been used to analyze DRGs packet flow in patients with chronic renal failure.Methods：the chronic renal failure cases and related data in three general hospitals of Xinjiang in 2012 were collected.The main deterninants were found using path analysis.Results：For patients with chronic renal failure,medical expenses mainly consisted of treatment costs,pharmaceutical fees,and examination fees,while the determinants included the length of hospital stay,methods of dialysis,the use of ICU,the additional number of diagnoses,complications,and age group.Conclusion：The main source of expenses in patients with chronic renal failure was treatment fees,pharmaceutical fees,and examination fees.It has been suggested that the DRGs packet process should be combined with the region and hospital data for analysis.DRGs-PPS should attempt to use path analysis of disease before preparing DRGs packets.