基于疾病诊断相关分组的儿童胃镜治疗技术资源优化研究

Optimization for technical resources of children′s gastroscopy based on diagnosis-related groups

目的:基于疾病诊断相关分组(DRG)对某儿童医学中心胃镜治疗技术进行分析,提出资源优化建议。方法:对某儿童医学中心22家医疗机构的2018年住院病案首页数据进行DRG分组,选择胃镜治疗操作组(GK3)病例,对该分组病例的疾病诊断、手术操作、付费方式进行分析。结果:22家医疗机构中,16家收治了GK3组病例,且例数差异显著,为2~917例。其中,代码M的机构以内镜多次治疗食管狭窄为特色,但其他大部分机构较少开展食管狭窄治疗。GK3组构成比最高的M机构患儿的主要付费方式为全自费,其次为外埠医保;而构成比列第二、三位的O和P机构收治患儿的主要付费类型为本市医保。结论:各机构采取儿童胃镜治疗食管狭窄技术的差距较大,可以通过儿科医疗联合体建设来实现优质医疗资源下沉,不断拉平区域间医疗技术差距。

Objective To analyze the gastroscopy treatment technology in a Children′s Medical Center based on the diagnosis-related groups(DRG)and put forward suggestions for resource optimization.Methods The data of the front pages of medical records of 22 medical institutions in a Children′s Medical Center in 2018 were divided into DRG groups.The patients in gastroscope treatment operation group(GK3)were selected,and the disease diagnosis,operation and payment methods of the patients in this group were analyzed.Results Of the 22 medical institutions,16 had GK3 group cases,and the number of cases was significantly different,ranging from 2 to 917.Among them,the institution with code M was characterized by multiple endoscopic treatment of esophageal stricture,but most other institutions rarely carried out the treatment of esophageal stricture.In GK3 group,the main payment method of children in Institution M with the highest constituent ratio was at one′s own expense,followed by non-local medical insurance.The main payment type of O and P institutions with the second and third constituent ratio was local medical insurance.Conclusions The gap of the technology of gastroscopy in the treatment of esophageal stricture is large in all institutions.The high-quality medical resources can be sunk through the construction of pediatric medical alliance,and the gap between the regional medical technology can be continuously leveled.