C-DRG的分组原则与方法

Grouping Principles and Methods of C-DRG

全国按疾病诊断相关分组收付费规范》(Pricing and Payment Regulation on Chinese Diagnosis-Related Groups,C-DRG)是基于我国患者特征和临床诊疗实践制定的住院服务收付费规范。分组方案是C-DRG体系核心的技术内容,其遵循临床相似性优先、资源消耗相似性为辅、临床咨询与数据校验相结合的原则,设置可管理数目的DRG组。C-DRG分组设计为四级分类,通过37个专业700余名国家级临床专家咨询完成临床分组,在此基础上以病例复杂性指数(PCI)为主要指标对住院病案进行数据分组,最后得到23个主要诊断类别下484个基本组和958个DRG组。随着临床诊疗实践发展和医疗成本变化,C-DRG分组也需进行动态更新与维护。

The Pricing and Payment Regulation on Chinese Diagnosis-Related Groups（C-DRG） was self-designed DRG pricing and payment system used for hospital inpatients in China, which was fully based on Chinese patient characteristics and clinical prac- tices. The core technical part of C-DRG system was grouping process, which followed the principles of giving priority to clinical homo- geneity and factoring in the resources utilization, as well as combining clinical consulting with data verification, and outputs DRGs whose quantity was manageable. C-DRG was designed in a 4-｜evel construction. The clinical grouping was achieved hy clinical consulting with more than 700 clinicians of 37 specialties, statistical grouping was accomplished with PCI as the major indicator. 23 main diagnosis catalogue comprising 484 ADRGs and 958 DRGs were produced. C-DRG grouping should be adjusted and updated in accordance with the development of clinical practices and the changing of medical costs.