按病种分组付费对急性脑梗死医疗质量影响分析

Analysis of the Influence of DRGs-PPS on the Medical Quality of Acute Cerebral Infarction

目的分析北京市某三甲医院按病种分组付费对急性脑梗死医疗质量的影响,探讨政策影响。方法筛选提取某医院2012年1月1日-2018年12月31日急性脑梗死的住院病例9957例,其中入DRG组5434例,非DRG付费组4523例,通过病案统计系统提取人口学资料信息;HIS系统提取具体医疗过程指标,进行医疗过程质量分析。结果 2012年-2018年急性脑梗死出院病例9957例纳入分析,在抗血小板治疗、血脂评价、预防深静脉血栓、康复评价与实施和血管功能评价五项关键过程质量评价指标将年龄、性别、民族、病例来源、婚姻状态以及主要诊断作为自变量,采用多因素Logistic回归进行统计分析,医疗质量过程指标除康复评价与实施应用比较P<0.01,差异具有统计学意义外,其他四项指标两组间比较,P>0.05,差异无统计学意义;康复评价与实施的应用中DRG付费组应用率高于非DRG付费组(OR=1.27,95%CI:1.03-1.57)。结论由结果可见DRG付费政策实施未造成急性脑梗死住院患者医疗质量的差异,没有对正常医疗质量造成影响。

Objective To analyze the impact of hospital-based payment on the quality of acute cerebral infarction in a hospital in Beijing,and to explore the impact of policy.Methods 9957 patients with acute cerebral infarction in a hospital from January 1,2012 to December 31,2018 were selected,including 5434 cases in DRG group and 4523 cases in non-DRG payment group.Demographic data were extracted by medical record statistics system,and specific medical process indicators were extracted by HIS system to analyze the quality of medical process.Results In the period of 2012-2018,9957 cases of acute cerebral infarction were included in the analysis.The five key process quality evaluation indicators in antiplatelet therapy,blood lipid evaluation,prevention of deep vein thrombosis,rehabilitation evaluation and implementation and vascular function evaluation were age,gender,ethnicity,Case source,marital status and main diagnosis were used as independent variables.Multivariate logistic regression was used for statistical analysis.Except for the comparison between rehabilitation evaluation and implementation(P<0.01),there was no significant difference in the other four indexes between the two groups(P>0.05).The application rate of the DRG payment group in the application is higher than that of the non-DRG payment group(OR=1.27,95%CI:1.03-1.57).Conclusion Statistical results show that the implementation of the DRG payment policy did not cause differences in the quality of medical care for patients with acute cerebral infarction,and did not affect the quality of normal medical care.