基于医保大数据的我国急诊医保患者急（抢）救药品使用现状

Present situation about the medical resources used for emergency patients with medical insurance in China based on analysis of large numbers of data

目的了解当前我国急诊医保患者急（抢）救药品使用现状及特点。方法采用回顾性医保数据挖掘与整合分析的方法，利用全国医疗保险抽样数据库（2014—2016），统计分析我国急诊医保患者急（抢）救药品用药金额、处方频次、次均费用（每人次平均费用）及在急诊总体用药中的占比等情况，并进一步按医疗机构等级及各抽样城市分别统计分析。结果研究数据涉及急诊医保患者用药信息约6342万条，从中筛选出100种品规的急（抢）救药品用药信息近26万条；我国急诊医保患者急（抢）救药品的使用占整体急诊用药比例较低，且急（抢）救药品应用品规较为集中，破伤风抗毒素注射液（1500U）、葡萄糖注射液（20mL：50％）、甘露醇注射液（250mL：50g）为全国单品规处方频次前3位的急（抢）救药品；三级医院急（抢）救药品用药金额和处方频次在各级医疗机构中占比最高，其占急诊总体用药的比例也居首位；三线城市虽急（抢）救药品用药金额和处方频次占全国总体比例不高，但在急诊总体用药中的占比最高，一线大城市则刚好相反；全国各等级医疗机构及各抽样城市中，除部分药品外，多数品规的急（抢）救药品使用情况差异不明显。结论当前我国急诊医保患者急（抢）救药品的使用现状和特点一方面可能与我国急诊的双重职能特点及急（抢）救病种特点相关，另一方面可能受药品临床需求、临床顺应性以及配备与短缺情况影响。本研究提供了近三年来我国急诊医保患者急（抢）救药品临床使用情况，可为今后的急（抢）救药品目录调整提供一定的临床数据支持。

Objective To investigate the current status and features of the use of medical resources for emergency patients with medical insurance in China clarified by analysis of large numbers of data. Methods Using the database from China Medical Insurance Research Association＇s research group, the total amount and the average cost of emergency medicines for patients with medical insurance, as well as the proportion of emergency medicines in total medical resources used in the emergency department were statistically analyzed. Additional analyses were made based on cities and medical institutions of different levels. Results The data were collected from more than 63 million pieces of medication information, from which 260 thousand pieces of information involved in emergency medicine used within 100 sorts of emergency medicines. The use of emergency medicines for emergency cases accounted for a low proportion of over all medicine used in emergency department in our country, and the specifications of emergency medicine were limited in a few kinds of medicine such as tetanus antitoxin injectio （1500 U）, 50% glucose solution in 20 ml water, and 50 g mannitol in 250 ml water frequently used as the leading essential agents. The sum of consumption of emergency medicines in tertiary hospitals was the highest among all levels of medical institutions, and the proportion of which in all medicine used in the emergency department also in the first place of the list. In the third-tier cities, although the sum of consumption of emergency medicines accounted for a small proportion of the whole country, the proportion of which in all kinds of medicine used in the emergency department was highest, while the situation of first-tier cities was just on the contrary. Except for only a few medicines, the ranking of the use of any emergency medicine else varied little in different cities and in various medical institutions. Conclusions On one hand, the current status and characteristics of the use of emergency medicines for emergency patients with medical insurance in China may be related to the characteristics of emergency departments and emergency cases, and on the other hand, they could also be influenced by medicines in clinical needs, clinical compliance, and shortages. This study showed the clinical application of emergency medicines in China in the past three years, which can provide some clinical data for the revision of emergency drug list in the future.