基于DRGs探讨急性胆囊炎住院天数及费用的科室差异

Hospitalization days and costs of patients with acute cholecystitis in different departments by DRGs

分析急性胆囊炎患者在不同科室不同诊断相关分组( DRGs)的住院天数和费用的差异情况,为临床医疗管理提供科学参考.方法收集某医院2017年急性胆囊炎的出院患者病案首页信息,运用医院绩效分析系统计算DRGs分类结果,采用非参数Kruskal-Wallis H检验分析不同科室不同DRGs组间住院天数及费用的差异.结果在不同科室手术患者与非手术患者中,肝胆外科的平均住院日最短,住院费用最低(P<0.05);相同DRGs组中肝胆外科平均住院日低于消化内科和胃肠外科(均P<0.05);"急性胆道疾病伴有并发症和伴随症"DRGs组科室间费用差异无统计学意义(P>0.05);在"急性胆道疾病不伴有并发症和伴随症"和"经腹腔镜胆囊切除术不伴有胆总管探查术"DRGs组中,肝胆外科的平均费用最低,胃肠外科的平均费用最高(P<0.05).结论某医院肝胆外科治疗急性胆囊炎效率优于其他科室;医疗机构应遵循专科专治原则,减少跨学科收治患者,加强专科化管理,提升科室专业竞争力.

Objective To analyze the differences in hospitalization days and costs of patients with acute cholecystitis in different departments or diagnosis related groups(DRGs), and provide scientific references for clinical medical management. Methods All the medical record homepages of the patients with acute cholecystitis were selected from a tertiary hospital from January 2017 to December 2017.The hospital analysis system of DRGs was used to calculate the classification results of DRGs.The Kruskal-Wallis H test was used to analyze the differences in hospital stays and costs between different DRGs or departments. Results The average length of stay was the shortest and the hospitalization cost in the department of hepatobiliary surgery was lower than other departments among patients with surgery and non-surgical(all P<0.05);The average length of stay at the department of hepatobiliary surgery was lower than the same other DRGs groups, namely the department of digestive medicine and gastrointestinal surgery(all P<0.05). There was no significant difference in the cost of " acute biliary tract disease with complications" between the various departments(P>0.05). The average cost in the department of hepatobiliary surgery was the lowest, and the average cost of gastrointestinal surgery was the highest in two DRGs of " acute biliary disease without complications and concomitant symptoms" and " laparoscopic cholecystectomy without common bile duct exploration"(all P<0.05). Conclusions Department of hepatobiliary surgery was better than other departments in the treatment of acute cholecystitis.Medical institutions should follow the principle of special treatment to reduce interdisciplinary patients and improve the professional competitiveness of the department.