精细化DRGs在缺血性脑梗死医保支付管理中的运用

Application of DRGs in medical insurance payment management of ischemic cerebral infarction

[目的]建立缺血性脑梗死科学的、精细的疾病诊断相关分组(DRGs)医保支付模型。并制定医疗费用偿付标准和超标费用的阀值。[方法]通过专家访谈法,寻找影响缺血性脑梗死医疗费用的相关因素。收集2014-2015年10家上海市三级甲等医院缺血性脑梗死城镇职工医疗保险患者的住院病例,采用单因素方差分析和多元线性逐步回归,确定影响住院费用的主要因素,运用决策树法对缺血性脑梗死患者进行DRGs分组。[结果]治疗方式、并发症、NIHSS评分为分组的分类节点变量,以此建立7个DRGs组合住院费用标准。[结论]DRGs分组结果可为住院费用支付方式的转变以及对住院医疗费用的控制提供参考及依据。

Objective To establish a scientific and precise DRGs medical insurance payment model for ischemic cerebral infarction Formulate the standard of medical expense reimbursement and the threshold of exceeding standard cost. Methods We found the related factors that affected medical costs of ischemic cerebral infarction through interviewing experts. From 2014 to 2015, inpatient cases with urban medical insurance were collected from 10 three -level first class hospitals in Shanghai. Patients with ischemic cerebral infarction were divided into DRGs groups according to the method of decision tree. One way ANOVA and multiple linear regression were used to determine the main factors affecting the cost of hospitalization Results We established 7 DRGs hospitalization expense standard by treatment method, complications and NIHSS score. Conclusions DRGs grouping result can provide reference basis for the change of hospitalization expense payment mode and controlling hospitali- zation expenses.